Macular pseudoholes with lamellar cleavage of their edge remain pseudoholes

To reappraise macular pseudohole characteristics using spectral-domain optical coherence tomography (OCT) and characteristics and postoperative outcomes of macular pseudoholes.

Retrospective, observational case series.

In this institutional study, 54 eyes with macular pseudohole were selected among 369 patients examined for an epiretinal membrane (ERM) by Cirrus spectral-domain OCT (Carl Zeiss Meditec) within a 2-year period. The diagnosis of macular pseudohole was based on the presence of a deep foveal pit, with verticalized edges and a macula thickened by the contraction of an ERM. All eyes underwent color fundus photography and spectral-domain OCT examination comprising a macular map, line raster scans, and en face images of the inner retinal surface. The main outcome measures were the morphologic description of the foveal profile in macular pseudoholes in relation to the pattern of the ERM contraction and the postoperative changes.

In 24 eyes, the foveal pit had vertical, straight, smooth edges on the OCT scan corresponding to centripetal contraction of the ERM. Thirty other eyes exhibited some degree of stretching and cleavage of the foveal pit edge resulting from asymmetrical tangential traction of the ERM between multiple epicenters of contraction. Thirty-three patients underwent surgery, and their macular profile and visual acuity improved whatever their initial foveal profile.

The OCT profile of macular pseudohole varies according to the pattern of the causal ERM contraction. Macular pseudoholes with a stretched foveal edge respond to ERM peeling as positively as other eyes and should not be confounded with macular lamellar holes.