Comprehensive Review of Retinal Pseudo-Holes: Clinical Presentation, Diagnosis, Pathophysiology, and Management

Clinical Presentation, Diagnostic Approaches, Pathophysiology, and Management of Retinal Pseudo-Holes: a Comprehensive Synthesis of 35 Peer-Reviewed Studies

Retinal pseudo-holes (RPH) are macular abnormalities that mimic macular holes (MH) but lack full-thickness retinal disruption. This systematic review, based on 35 studies, explores their clinical presentation, diagnosis, pathophysiology, and management.

Diagnosis: Differentiating RPH from MH is challenging due to overlapping symptoms such as central scotomas and visual distortion. Optical coherence tomography (OCT) has become the gold standard for diagnosis, surpassing older imaging techniques like fundus photography and fluorescein angiography. OCT provides detailed, non-invasive imaging that helps identify RPH's hallmark feature: a foveal depression without retinal break.

Pathophysiology: RPH is primarily caused by mechanical forces exerted on the macula by epiretinal membranes (ERM) and vitreomacular traction (VMT). These forces distort the retina, creating a pseudo-hole. Risk factors include aging, high myopia, trauma, and diabetes.

Management: Many RPH cases are managed conservatively with regular monitoring, as the condition often remains stable. Surgical intervention, such as pars plana vitrectomy (PPV) with membrane peeling, is reserved for symptomatic cases with significant visual impairment. Surgery has shown promising outcomes, with most patients experiencing improved visual acuity.

Research Needs: Further studies are needed to explore the long-term outcomes of RPH, identify factors predicting progression to MH, and assess the utility of advanced imaging techniques like OCT angiography in improving diagnosis and monitoring.

This review underscores the importance of accurate differentiation between RPH and MH to ensure appropriate management and avoid unnecessary treatments.

Study Overview

• Status: Completed
• Conditions: Epiretinal Membrane; Age-related Disease; Idiopathic ERM

Detailed Description

This is a REVIEW study on Retinal pseudo-holes.

• Study Type: Observational
• Enrollment (Actual): 10

Contacts and Locations

Study Locations

• Iran, Islamic Republic of
  • Hamadan, Iran, Islamic Republic of
    • Hamadan University of Medical Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

35

Description

Inclusion Criteria:

• Studies that directly addressed retinal pseudo-holes, their clinical presentation, diagnostic modalities, pathophysiology, or treatment.
• Peer-reviewed clinical trials, case reports, observational studies, and reviews.
• Studies that utilized OCT or other imaging techniques (such as fluorescein angiography or fundus photography) to diagnose retinal pseudo-holes.
• Studies that were published in English and provided full-text access.

Exclusion Criteria:

• Studies that did not specifically focus on retinal pseudo-holes but instead dealt with other retinal conditions (e.g., full-thickness macular holes, retinal detachment).
• Studies that were not peer-reviewed (e.g., conference abstracts, opinion pieces).
• Non-English language studies or those without available full texts.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Retinal Thickness	Measuring retinal thickness using Optical Coherence Tomography (OCT) to assess structural changes associated with the severity of the epiretinal membrane. Unit of Measure: Micrometers (µm)	up to 12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Acuity	Evaluating patients' visual acuity using the LogMAR scale to determine the functional impact of the epiretinal membrane on vision. Unit of Measure: LogMAR (logarithm of the minimum angle of resolution)	up to 10weeks

Collaborators and Investigators

• Sponsor: Mohammad Reza Tokhmehchi

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2024
• Primary Completion (Actual): August 20, 2024
• Study Completion (Actual): September 25, 2024

Study Registration Dates

• First Submitted: January 12, 2025
• First Submitted That Met QC Criteria: January 28, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 28, 2025
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Eye Diseases; Retinal Diseases; Epiretinal Membrane
• Other Study ID Numbers: IR.GUMS.REC.1400.134

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No