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Michelle C. Liang, Caio V. Regatieri, Jason Y. Zhang, Ahmad A. Alwassia, Jay S. Duker; Persistent Retinal Cysts in Exudative Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):804.
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To analyze the occurrence of persistent retinal cystic structures over scars and areas of chorioretinal atrophy in patients with exudative age-related macular degeneration (AMD).
A retrospective case review identified 119 patients (238 eyes) with exudative AMD treated with anti-vascular endothelial growth factor (VEGF) agents. Patients were scanned using the Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, California). The presence of fibrous scar formation and chorioretinal atrophy were determined by fundus photography and noted on OCT, and the presence, location, and persistence of cystic structures within the retina were documented.
Scar formation detected on photographs was present in 42 of 238 eyes (17.6%). Eleven of the 42 eyes (26%) demonstrated retinal cysts overlying the scars on OCT. Chorioretinal atrophy was observed in 108 eyes (45.4%), 22 of which had cystic structures overlying the atrophy on OCT. Most cysts were located in the outer retina (83.1% in patients with scar formation, 68.7% in patients with atrophy) and located directly over the area of pathology. In the patients with scarring, 32 cysts in 10 eyes persisted over an average of 11.9 ± 5.5 months, despite 6 of these eyes receiving an average of 8 ± 4 injections with anti-VEGF agents. In the patients with chorioretinal atrophy, 17 cysts in 11 eyes persisted over 9.3 ± 4.6 months with 8 of these eyes undergoing an average of 12 ± 6 anti-VEGF injections. A total of 17 outer retinal tubulations were observed in 14 eyes, 7 associated with scarring and 10 with atrophy.
Retinal cysts over fibrotic scars in patients with treated exudative AMD are present in 26% of eyes and do not seem to be affected by further treatment with anti-VEGF agents. These structures are unlikely to represent a sign of active choroidal neovascularization and their presence should not be an indication for re-treatment.
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