Macular Pseudohole

Overview

Macular pseudohole is caused by the invagination of the foveal via centripetal tangential traction of an epiretinal membrane (ERM).

Clinically, a discrete reddish round lesion can be seen at the macula and its appearance may mimic a full thickness macular hole.

On OCT, a macular pseudohole is defined by three characteristics: the presence of a verticalized or steepened foveal profile, retinal thickening and an ERM sparing the foveal centre.

Case Examples

  • Case 1

    A 65 year old Caucasian male with best corrected visual acuity of 6/6 (20/20) in the right eye.

    Fundus photo and red-free image (right eye)

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    Fundus photo and red-free image (right eye)

    There is a reddish appearance to the macula in the colour image. The discrete nature of the lesion is best appreciated on red-free viewing. This image also shows some fine lines radiating out from the macula centre which are characteristic of an ERM.

    Spectralis OCT line scan (right macula)

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    Spectralis OCT line scan (right macula)

    OCT shows a steepening of the foveal pit (macular pseudohole). The undulations of the retinal surface layers (most notable temporally) is due to the contraction of the ERM.

    Spectralis OCT volume scan (right macula)

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    Spectralis OCT volume scan (right macula)

    This volume scan shows the ERM as a hyper reflective layer at the inner retinal surface, associated with contraction and subsequent surface irregularity. At the fovea there is steepening of edges of the pit.

  • Case 2

    A 68 year old Asian male with best corrected visual acuity in the right eye of 6/7.5- (20/25-).

    Fundus photo and red-free image (right eye)

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    Fundus photo and red-free image (right eye)

    The macula has a discrete red lesion that resembles the appearance of a full thickness macular hole. The red-free image shows a glistening pattern radiating out from the macular centre which is consistent with an ERM.

    Spectralis OCT macula line scan (right eye)

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    Spectralis OCT macula line scan (right eye)

    OCT shows a distinct ERM, seen on the retinal surface as a hyper-reflective line. Contraction of the ERM has caused undulations of the inner retinal surface. There is notable retinal thickening and distortion of the normal foveal pit.

References

Stalmans, P. Duker, J. Kaiser, PK. Heier, JS. Dugel, P et al. (2013) OCT-Based interpretation of the vitreomacular interface and indications for pharmacologic vitreolysis. Retina Volume 33 - Issue 10