Clinical presentation, diagnostic approaches, pathophysiology, and management of retinal pseudo-holes: a comprehensive synthesis of 35 peer-reviewed studies
Notice bibliographique
Résumé
Background: Retinal pseudo-hole (RPH) is a macular configuration defined on optical coherence tomography (OCT) by foveal depression without a full-thickness retinal defect, and may clinically resemble true/full-thickness macular hole (MH). Misclassification has therapeutic consequences. Objective: To synthesize evidence on the clinical presentation, diagnostic yield of imaging, pathophysiology, and management of RPH, with prespecified quantitative pooling where valid. Methods: A PRISMA-aligned systematic review identified 35 peer-reviewed studies (1990–2024). Two reviewers independently screened/extracted data (κ = 0.86) and appraised risk of bias (Cochrane RoB, Newcastle–Ottawa, adapted tools). Quantitative meta-analysis was performed only when outcomes, time-points, and variance were compatible. Results: Patients most commonly reported metamorphopsia, central scotoma, and blurred vision; many had preserved or mildly reduced BCVA. OCT consistently demonstrated the defining RPH signature and frequently revealed epiretinal membrane (ERM) and/or vitreomacular traction (VMT) that informed management; fluorescein angiography and fundus photography were adjunctive rather than discriminatory. Eleven of the 35 studies (11 studies) met pooling criteria for visual outcomes after pars plana vitrectomy (PPV) ± ERM peeling: the pooled mean BCVA improvement was + 2.1 Snellen lines (95% CI + 1.7 to + 2.5, p < 0.001; I 2 = 46%), and 70.3% (95% CI 63.9%–75.9%) achieved a ≥2-line gain (I 2 = 38%). Sensitivity analyses excluding high-risk studies produced similar effects (+2.0 to + 2.2 lines) with modestly reduced heterogeneity. Few studies reported extractable 2 × 2 data; therefore, pooled sensitivity/specificity for OCT was not estimated. Conclusions: Evidence supports an OCT-first, traction- and symptom-guided pathway: observation with serial OCT for minimally symptomatic RPH, and PPV ± ERM peeling for traction-positive, function-limiting presentations, with clinically meaningful average visual gains and low complication rates in experienced settings. Conclusions should be tempered by the heterogeneity and the fact that only 11 of 35 studies were quantitatively combinable; standardized outcomes and rigorous diagnostic-accuracy studies are priorities. Abstract Retinal pseudo-holes (RPH) are macular abnormalities that mimic accurate macular holes (MH) but lack full-thickness retinal disruption. This systematic review synthesizes findings from 35 peer-reviewed studies on the clinical presentation, diagnostic methods, pathophysiology, and management strategies for retinal pseudo-holes. The review highlights the challenges of diagnosing RPH due to its clinical similarity to MH, emphasizing the critical role of optical coherence tomography (OCT) in distinguishing between the two conditions. The pathophysiology of RPH is primarily attributed to vitreomacular traction (VMT) and epiretinal membranes (ERM), which exert mechanical forces on the macula, leading to a foveal depression. Management approaches range from conservative observation to surgical intervention, depending on the severity of symptoms. Surgical treatments, particularly pars plana vitrectomy with membrane peeling, have shown promising results in improving visual acuity, particularly in symptomatic patients. The review also discusses the need for further research into the long-term outcomes of RPH and the potential for newer imaging technologies to improve diagnostic accuracy and monitoring.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».