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T.A. Albini, M.S. Benz, A.C. Westfall, R.R. Lakhanpal, A.R. McPherson, E.R. Holz; Optical Coherence Tomography of Foveal Cystoid Hyporeflective Spaces Without Evidence of Macular Edema in Group 2A Idiopathic Juxtafoveolar Telangiectasia . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1539.
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Purpose: Prior to developing choroidal neovascularization (CNV), patients with group 2A juxtafoveal telangiectasis (JFT) often experience gradual central visual loss associated with focal atrophy of the foveolar retina, which in some cases simulates a lamellar hole without biomicroscopic or fluorescein angiographic evidence of cystoid edema. Although this clinical finding has been well described in the literature, it has not been confirmed by optical coherence tomography (OCT). Methods: This study is a retrospective review of patient charts, OCT, fundus photography, and fluorescein angiography involving 15 patients (25 eyes) undergoing OCT examinations with a diagnosis of JFT at the McPherson Retina Center, Baylor College of Medicine. In all cases concurrent color fundus photography and fluorescein angiography was available. All angiograms were reviewed by a single reader (M.S.B.), who was masked to the patient charts and OCT findings. All cases of JFT were staged according to the scheme suggested by Gass. Patient race, age, gender, the presence of diabetes mellitus, and Snellen visual acuity in each eye was recorded. Results: Average patient age was 64.5 (range: 38 to 77). Female to male ratio was 1:1.6. Visual acuity ranged from 20/20 to 20/200. Three patients had bilateral mild nonproliferative diabetic retinopathy (NPDR). Two eyes had stage 1 JFT and normal OCT examinations. Fifteen eyes had stage 3 disease; of these, 9 had presence of large cystic foveal hyporeflective spaces without macular edema on OCT, and two eyes with NPDR had evidence of cystoid edema. Four eyes had stage 4 disease; of these, 3 showed areas of intraretinal hyperreflectivity consistent with intraretinal pigment. Four eyes had stage 5 disease; all showed evidence of CNV on OCT. Conclusions: Foveal cystoid hyporeflective spaces without evidence of macular edema were commonly seen on OCT of stage 3 JFT (9 of 15 eyes). It is important to distinguish these cystic spaces from cystoid macular edema, since these two lesions may differentially respond to therapy. The cystic spaces seen on OCT of stage 3 JFT are anatomically similar to lamellar holes in location and size and may represent focal atrophy of the foveolar retina.
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