Foveal pseudocyst as the first step in macular hole formation: A prospective study by optical coherence tomography☆
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Patients and methods
From January 1997 through November 1999, we examined 22 eyes of 20 patients with a foveal pseudocyst at presentation, using OCT. Eight were the fellow eye of an eye with a macular hole, and 14 were diagnosed in patients with visual symptoms in only one eye. The age of the patients (17 women and 3 men) ranged from 59 to 77 years (mean, 68 years). Clinical and OCT examinations were performed at the initial visit, as well as at follow-up examinations scheduled every 2 months. The mean follow-up
Initial examination
Sixteen eyes were examined after the onset of visual symptoms, including decreased vision or metamorphopsia. Eight of them were fellow eyes of eyes with macular holes. The six others were asymptomatic but were examined because the patient had a macular hole in the fellow eye.
Biomicroscopy
The vitreous was considered to be attached in all cases because no Weiss ring was seen on biomicroscopy. Foveal cystoid changes or pseudocyst associated with variously prominent radial striae were seen on biomicroscopy in
Discussion
Although the primum movens of macular hole formation remains unexplained, the sequence of events leading to the initial stages of this formation are now well documented. Several authors already postulated many years ago that the initial stages of macular hole formation were the result of the process of posterior vitreous detachment.1, 10, 11, 12, 13 More recently, Hee et al7 showed, with OCT, that when a foveal cyst developed in the fellow eye of an eye with a macular hole, the partially
Conclusions
Foveal pseudocyst is a specific entity that may constitute a primary feature in one eye or may involve the fellow eye of an eye with a macular hole. It is always related to a partial perifoveal posterior hyaloid detachment on OCT scans. Optical coherence tomography shows also that the pseudocyst usually occupies the inner part of the foveola, which results in foveolar thickening and corresponds to a stage 1A impending macular hole. In the stage 1B impending hole, characterized by a yellow ring
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The authors have no proprietary interest in any aspect of this study.