Elsevier

Ophthalmology

Volume 108, Issue 1, January 2001, Pages 15-22
Ophthalmology

Foveal pseudocyst as the first step in macular hole formation: A prospective study by optical coherence tomography

Presented in part as a poster at the annual meeting of the Association for Research on Vision and Ophthalmology, Fort Lauderdale, Florida, May 1999.
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Abstract

Objective

To establish the natural history of a series of impending macular holes presenting as foveal pseudocysts using optical coherence tomography (OCT).

Design

In a prospective observational case series, patients exhibiting a foveal pseudocyst on biomicroscopy were examined with OCT and were followed up for 3 to 26 months (mean, 9.4 months)

Participants

Twenty-two eyes of 20 consecutive patients examined for a macular hole in the fellow eye or reporting visual symptoms in only one eye, in whom a foveal pseudocyst was diagnosed on OCT.

Methods

In all cases, fundus biomicroscopy and OCT findings were compared.

Main outcome measures

Biomicroscopic fundoscopy, OCT scans, and visual acuity.

Results

Eight foveal pseudocysts occurred in the fellow eye of an eye with a macular hole, and 14 were diagnosed in patients with unilateral visual symptoms. In four of the 22 eyes, the macula was considered normal on biomicroscopy. In the 18 others, biomicroscopy detected a foveal pseudocyst, radial striae, a yellow spot or ring, or a combination of these findings. No posterior vitreous detachment was seen on biomicroscopy in any of the eyes. On OCT, the cystoid space occupied the inner part of the foveal tissue in the stage 1A impending hole; a stage 1B impending hole corresponded to a cystoid space that extended posteriorly, disrupting the outer retinal layer. During the follow-up period, three pseudocysts evolved into full-thickness macular holes, four turned into lamellar holes, seven resolved completely after detachment of the posterior hyaloid, and eight remained unchanged for a long time.

Conclusions

Foveal pseudocysts are a specific entity occurring either as a primary ocular involvement or in the fellow eye of an eye with a macular hole. Foveal pseudocysts are the first step of full thickness macular hole formation, but they also may evolve into a lamellar hole, may persist unchanged for months, or may resolve completely. Foveal pseudocyst formation may be the result of the incomplete separation of the vitreous cortex at the foveal center and the particular structure of the foveal Müller cells.

Section snippets

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.

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