What is Posterior Impending Syndrome?
The term "posterior impending syndrome" does not exist in ophthalmology or medical literature—you may be referring to "impending macular hole" (also called stage 1 macular hole), which represents early vitreoretinal traction at the fovea that may progress to a full-thickness macular hole.
Impending Macular Hole (Stage 1)
An impending macular hole is characterized by foveal cysts caused by persistent vitreomacular traction (VMT) that has not yet progressed to a full-thickness defect. 1
Clinical Features
- Stage 1-A: Small yellow spot at the fovea with loss of the foveal depression 1
- Stage 1-B: Yellow ring at the fovea representing more advanced cystic changes 1
- Patients typically present with metamorphopsia (distorted vision) or mild central visual acuity loss 1
- OCT imaging shows vitreous attachment to the fovea with underlying cystic changes 1
Natural History and Prognosis
Only approximately 50% of stage 1 lesions progress to full-thickness macular holes—the other 50% spontaneously resolve when the vitreous detaches from the fovea. 1
- When spontaneous vitreous separation occurs, the foveal appearance often returns to normal or appears as a reddish spot with rapid improvement in visual symptoms 1
- Patients with foveal cysts can remain stable with good vision for up to 5 years 1
- Early detection is critical because smaller holes and shorter duration of macular compromise are associated with better surgical outcomes 1
Management Approach
Most patients with stage 1 macular holes and good central visual acuity should be observed rather than treated surgically. 1
- Observation is preferred because vitrectomy surgery to prevent full-thickness macular hole formation has been shown to have no effect on the rate of progression 1
- Patients should be educated about warning signs (worsening metamorphopsia or central vision changes) and instructed to return promptly if symptoms worsen 1
- OCT imaging of the fellow eye helps identify at-risk eyes by detecting vitreous traction at or near the macula 1
When Surgery Becomes Necessary
If progression to stage 2 or beyond occurs (full-thickness macular hole), vitrectomy surgery becomes indicated because:
- Untreated full-thickness macular holes lead to progressive central vision loss, typically to the 20/200-20/400 range 1
- Delays in repair reduce success rates and visual outcomes 1
- As holes enlarge, epiretinal membranes may develop and surgical success decreases 1
Common Pitfall
Do not confuse impending macular hole with other causes of vitreomacular traction or with posterior vitreous detachment complications affecting the peripheral retina. The term specifically refers to foveal pathology, not peripheral retinal changes. 1