Clinical presentation, diagnostic approaches, pathophysiology, and management of retinal pseudo-holes: a comprehensive synthesis of 35 peer-reviewed studies
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.027 | 0.105 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.010 | 0.013 |
| Bibliometrics | 0.022 | 0.016 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".