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Bilal Haj Najeeb, Christian Simader, Ursula Schmidt-Erfurth; The role of the macular intraretinal cysts in evolution of capillary drop out in diabetic macular retinopathy. A new mechanism. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2364.
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© ARVO (1962-2015); The Authors (2016-present)
It is well established that capillary drop out in diabetic retinopathy can be caused by sharing of different known mechanisms. Capillary cell apoptosis, inflammatory changes as well as vascular occlusion by white cells or platelets are known mechanisms. In our study we explore the pressure applied by the intra retinal cysts to occlude the overlying retinal capillaries.
44 consecutive patients with ischemic diabetic maculopathy were included. The outlines of non perfusion areas on fluorescein angiography in the central 3000 micron diameter macular field were studied and correlated with cystic spaces in the corresponding spectral domain optical coherence tomography.
35 patients (79.5%) showed correlation between non perfusion areas and the existence of intraretinal cyst(s) in the corresponding areas. The causing cystic spaces occupied at least the inner nuclear layer (INL) and the inner plexiform layer (IPL) of the inner retinal layers to begin a mechanical occlusive pressure on the overlying capillary networks. Profoundly leaking microaneurysm(s) was/were found around the non perfusion areas. However, in the other 9 cases we noticed a diffused capillary drop out that extended outside the studied area. The cysts, if excited, were randomly distributed without any specific configuration. More over, the cysts, situated exclusively in the outer retinal layers, did not have any correlation with the corresponding ischemic findings.
the pressure of the cystic spaces on the overlying retinal vasculature can cause ischemic maculopathy. This may indicate a prompt treatment of the macular cysts before they increase in size causing irreversible ischemic damage.
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