My Macular Pseudohole Experience and Surgery

Joy Efron
Joy R. Efron, Ed.D.

Some Background About My Surgeries

In 2007 I was diagnosed with epiretinal membranes in both eyes. I was told that this was an abnormal layer of cells on the retina that would be monitored, but that it was of no concern and was not affecting my vision.

In 2008 the epiretinal membrane developed into a wrinkle called a macular pucker. However, it was not affecting my vision; the plan was to monitor the macular pucker.

In 2009 I developed a full-thickness macular hole in my left eye and had vitrectomy surgery, followed by face-down positioning for six weeks. I achieved a remarkable visual recovery.

In 2012 I had the same vitrectomy surgery in my right eye due to a pseudohole, also known as a macular pseudohole. While I was certainly unhappy about the problem with my second eye, it was not a surprise.

How My Pseudohole Developed

Detecting My Pseudohole

At the end of 2010, I had an appointment with my ophthalmologist for a routine exam. I was shocked when he tentatively diagnosed me with a macular hole in my second (right) eye. I had no blurriness or distortion, as had been the case with the macular hole in my first (left) eye.

However, the subsequent retinal scan with optical coherence tomography (OCT) imaging showed that I did not have a macular hole. I had what is called a “pseudohole.” [Editor’s note: OCT is a type of medical imaging technology that produces high-resolution cross-sectional and three-dimensional eye images.] The OCT scan of a pseudohole looks very similar to that of a macular hole. However, it is not a true hole.

In a full-thickness macular hole, the OCT scan will confirm the absence of retinal layers and a full thickness defect in the retina. In contrast, the OCT scan of a pseudohole will reveal an epiretinal membrane with contraction of the retina and sometimes compression of the retinal layers, but no loss of retinal layers. The term “pseudohole” reflects the fact that although this looks like a macular hole, it is not a hole in the retina.

Would My Pseudohole Progress?

Would my pseudohole develop into a macular hole? My surgeon told me that there is no way of telling; sometimes, a pseudohole develops into a macular hole; usually, it does not. I inquired about preventive surgery for a pseudohole, due to my concern that it might become a macular hole. My surgeon told me that many retinal specialists are not willing to operate for a pseudohole when visual acuity is good and there is minimal visual distortion due to concerns about surgical risks and complications. These risks can include retinal detachment, cataract, and macular edema (swelling or the accumulation of fluids in the macula).

My Vision Becomes Affected

After 18 months, my vision started to become affected. Not only were layers of the retina severely compressed and thin, but my vision was affected. Unlike the macular hole in my left eye in 2009, I had no vertical or horizontal distortion; however, both my near and distance vision had become blurry, and I had small central blind spots. My visual acuity had deteriorated from 20/20 to 20/60 in my right eye.

At that point, my retinal surgeon decided it was time to operate. Unfortunately, I had to wait several months, as his schedule was very busy and my situation was not considered an emergency.

Surgery for My Pseudohole

My surgeon informed me that the procedure for a pseudohole would be the same as for a macular hole (vitrectomy with peeling of the internal limiting membrane), but with some uncertainties:

  • He might not need to use gas to insert a bubble in place of the vitreous; instead, he might use air. He might also use neither gas nor air and leave my eye with the standard saline solution used during vitrectomy surgery. Air dissipates much faster than gas. The average time for an air bubble to dissipate is 4-5 days, but it could be as short as three days or as long as 10 days. If gas were to be used, it would be different than that used three years earlier; it was faster acting than the previous gas. Surgeons learned in the intervening years that the hole closes faster than they had thought.
  • He would not know until operating whether or not I would need to be face-down and if so, for what period. If there was no hole when he operated and no complications, I probably would not need air or gas, nor would I need to be face-down. If there was a hole present in the retina, then air or gas would be used and I would need to position face-down.
  • I might be driving in two days or I might be face-down for a week or so.
  • I should expect my vision to be quite a bit worse for at least two months post-surgery than pre-surgery, even if I were to have saline solution or air instead of gas. Then my visual acuity would slowly start to get better – and then a cataract would probably start to form and my visual acuity would worsen again. It would be at least six months, but probably a year, to know about the final outcome.

Face-Down Positioning Was Required

I decided to order some vitrectomy face-down equipment in case I would need it, but did not include the kneeling massage face-down chair in my order. During the operation, my surgeon determined that I required the air, and I was told to stay face-down until the air bubble dissipated. This was anticipated to be 3-4 days (in contrast to the six weeks I was face-down in 2009).

After my first series of articles on my macular hole surgery and recovery, I had been communicating with many people who had surgery for macular holes. People with severe arthritis, neck and spinal degenerative problems, and chronic pulmonary problems cannot stay face-down. So it was certainly encouraging to learn that my face-down period was shortened considerably.

Unfortunately, it took 10 days for the air bubble in my eye to dissipate, and despite the comparison with six weeks in 2009, it was every bit as miserable as the first time. This may be due partially to the fact that I had not ordered the kneeling massage face-down chair in advance and it did not arrive until the fifth day I was face-down.

Additional Information on Macular Pseudohole

See Suggested Resources for more information about helpful products and organizations, as well as the author’s contact information.

A Disclaimer

I was an educator of blind and visually impaired children for 42 years. Although I have read and researched a great deal and have had extensive discussions with retinal specialists, I am not an ophthalmologist or medical doctor.

Reviewed and edited by Mrinali Patel Gupta, M.D., VisionAware Medical Consultant

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