Pseudo-Cysts: A Previously Undescribed Sign of Geographic Atrophy

Abstract

Purpose: : To describe the presence of pseudo-cysts in retinal layers in eyes with geographic atrophy (GA) of age-related macular degeneration (AMD) and to estimate their incidence.

Methods: : Retrospective analysis of consecutive patients with geographic atrophy assessed by spectral-domain OCT (Cirrus SD-OCT, Zeiss). Analysis of prevalence of pseudo-cysts in retinal layers. Statistical analysis (Chi2 test, Fischer’s exact test, Mann-Whitney U-test, Cramers’s test) were performed to research links between presence of pseudo-cysts and demographic features and/or pattern of atrophy, i.e. horseshoe, homogeneous area, homogeneous area with foveal sparing, and patchy atrophy.

Results: : Eighty eight eyes of 68 patients aged between 61 and 94 years (mean age: 79.8 years) were examined. Twenty patients had bilateral GA. Twenty-four eyes (27.2%) exhibited pseudo-cysts corresponding to cystoid spaces usually located in the inner nuclear layer of the retina. There was no macular edema. Fluorescein angiography, performed in 71 eyes (80%), ruled out choroidal neovascularization. No correlation was found between age (p=0.7) or gender (p > 0.99) of the patients and presence of pseudo-cysts. There was no association between patterns of atrophy (Cramers’s V=0.183) and presence of pseudo-cysts.

Conclusions: : To our knowledge, this is the first description of pseudo-cysts observed in spectral-domain OCT in atrophic AMD. They could correspond to Muller cells degeneration, as suspected in other degenerative retinal desorders like tamoxifen retinopathy or groupe 2A idiopathic juxtafoveolar retinal telangiectasis. Presence of pseudo-cysts appeared to be likely frequent in atrophic AMD. These pseudo-cysts should not be considered as exudative manifestations that would lead to inadequate therapies.

Keywords: age-related macular degeneration • imaging/image analysis: clinical • Muller cells