Original article
Retinal Pseudocysts in Age-Related Geographic Atrophy

https://doi.org/10.1016/j.ajo.2010.02.019Get rights and content

Purpose

To report the presence of pseudocysts in retinal layers of eyes with geographic atrophy (GA) attributable to age-related macular degeneration (AMD) and to estimate their prevalence.

Design

Retrospective study.

Methods

setting: Clinical practice. patients: Consecutive patients with GA, assessed by spectral-domain optical coherence tomography (OCT). main outcome measures: Assessment of pseudocyst prevalence in retinal layers. Statistical analysis by the χ2 test, Fisher exact test, Mann-Whitney U test, and Cramer test, performed to explore links between the presence of pseudocysts and demographic features and/or pattern of atrophy, ie, horseshoe, homogeneous area, homogeneous area or patchy atrophy with foveal sparing, and patchy atrophy.

Results

Eighty-eight eyes of 68 GA patients aged between 61 and 94 years (mean: 79.8) were examined. In 20 patients, GA was bilateral. Twenty-four eyes (27.2%) exhibited pseudocysts corresponding to small cystoid spaces frequently located in the inner nuclear layer of the retina. There was no macular edema. Fluorescein angiography, performed in 71 eyes (80%), ruled out possible choroidal neovascularization. No correlation was found between 1) patients' age (P = .7) or gender (P > .99) and the presence of pseudocysts or 2) patterns of atrophy (Cramer test: V = 0.183) and the presence of pseudocysts.

Conclusions

Pseudocysts seemed to be frequent in atrophic AMD. They might correspond to Müller cell degeneration, as suspected in other degenerative retinal disorders like tamoxifen retinopathy or group 2A idiopathic juxtafoveolar retinal telangiectasis. The present results indicate that pseudocysts are frequently seen on OCT in eyes with atrophic AMD and their presence should not be considered as a manifestation of neovascular AMD that requires prompt treatment.

Section snippets

Methods

At the Centre Ophtalmologique d'Imagerie et de Laser, a private-practice tertiary care retinal center in Paris, France, the charts and images of 68 consecutive patients with a diagnosis of GA in at least 1 eye were retrospectively reviewed over a period of 3 months.

Inclusion criteria were dry age-related macular degeneration with GA of at least half a disk area, imaged both by color fundus photography and SD-OCT. Some patients had also been imaged by fundus autofluorescence and fluorescein

Results

Eighty-eight eyes of 68 patients were included. Patients comprised 50 women (73%) and 18 men. They were aged from 61 to 94 years (mean age: 79.8 ± 7.9). Twenty patients had bilateral GA. The right eye was studied in 50 cases, and the left eye in 38.

Twenty-four of the 88 eyes (27.2%) exhibited pseudocysts corresponding to cystoid spaces (FIGURE 1, FIGURE 2, FIGURE 3). The 95% confidence interval for the prevalence estimate for pseudocysts is [17.72%–36.28%]. The pseudocysts were located just

Discussion

The present study reports the presence of pseudocysts in a subset of eyes presenting with typical GA. Pseudocysts were identified thanks to meticulous analysis of the defilade of the entire recorded square of the SD-OCT scans of the 88 eyes with GA, and were found in 24 eyes (27.2%). Recognition of pseudocysts may be of great importance, because numerous clinical studies now in progress are being performed to test potential therapies for dry AMD and are using OCT to monitor the course of

Salomon Y. Cohen received his MD from Paris University in 1990. He performed most of his ophthalmology residency in departments specialized in Retina, and his fellowship at the Creteil University Eye Clinic, chaired by Professor Gabriel J. Coscas. He has completed a PhD in Neurosciences, and is currently practicing as Retina specialist in private practice and at Hospital Lariboisière, Paris, in Professor Alain Gaudric's department. He has authored five books devoted to fluorescein angiography,

References (29)

  • U. Solbach et al.

    Imaging of retinal autofluorescence in patients with age-related macular degeneration

    Retina

    (1997)
  • H.G. Holz et al.

    Patterns of increased in vivo fundus autofluorescence in the junctional zone of geographic atrophy of the retinal pigment epithelium associated with age-related macular degeneration

    Graefes Arch Clin Exp Ophthalmol

    (1999)
  • R.T. Smith et al.

    Autofluorescence characteristics of early, atrophic, and high-risk fellow eyes in age-related macular degeneration

    Invest Ophthalmol Vis Sci

    (2006)
  • J.S. Sunness et al.

    Issues in quantifying atrophic macular disease using retinal autofluorescence

    Retina

    (2006)
  • Cited by (0)

    Salomon Y. Cohen received his MD from Paris University in 1990. He performed most of his ophthalmology residency in departments specialized in Retina, and his fellowship at the Creteil University Eye Clinic, chaired by Professor Gabriel J. Coscas. He has completed a PhD in Neurosciences, and is currently practicing as Retina specialist in private practice and at Hospital Lariboisière, Paris, in Professor Alain Gaudric's department. He has authored five books devoted to fluorescein angiography, indocyanine green angiography, ageing eye, age-related macular degeneration, and low vision rehabilitation. He has also authored more than 70 papers, most of them in peer-reviewed international journals. He is recipient of the American Academy of Ophthalmology Achievement Award.

    View full text