Foveal pseudocyst as the first step in macular hole formation - A prospective study by optical coherence tomography

Objective: To establish the natural history of a series of impending macula r holes presenting as foveal pseudocysts using optical coherence tomography (OCT). Design: In a prospective observational case series, patients exhibiting a f oveal pseudocyst on biomicroscopy were examined with OCT and were followed up for 3 to 26 months (mean, 9.4 months) Participants: Twenty-two eyes of 20 consecutive patients examined for a mac ular hole in the fellow eye or reporting visual symptoms in only one eye, i n whom a foveal pseudocyst was diagnosed on OCT. Methods: In all cases, fundus biomicroscopy and OCT findings were compared. Main Outcome Measures: Biomicroscopic fundoscopy, OCT scans, and visual acu ity. Results: Eight foveal pseudocysts occurred in the fellow eye of an eye with a macular hole, and 14 were diagnosed in patients with unilateral visual s ymptoms. In four of the 22 eyes, the macula was considered normal on biomic roscopy. In the 18 others, biomicroscopy detected a foveal pseudocyst, radi al striae, a yellow spot or ring, or a combination of these findings. No po sterior vitreous detachment was seen on biomicroscopy in any of the eyes, O n OCT, the cystoid space occupied the inner part of the foveal tissue in th e stage 1A impending hole; a stage 1B impending hole corresponded to a cyst oid space that extended posteriorly, disrupting the outer retinal layer. Du ring the follow-up period, three pseudocysts evolved into full-thickness ma cular holes, four turned into lamellar holes, seven resolved completely aft er detachment of the posterior hyaloid, and eight remained unchanged for a long time. Conclusions: Foveal pseudocysts are a specific entity occurring either as a primary ocular involvement or in the fellow eye of an eye with a macular h ole. Foveal pseudocysts are the first step of full thickness macular hole f ormation, but they also may evolve into a lamellar hole, may persist unchan ged for months, or may resolve completely. Foveal pseudocyst formation may be the result of the incomplete separation of the vitreous colter at the fo veal center and the particular structure of the foveal Muller cells. Ophtha lmology 2001;108:15-22 (C) 2001 by the American Academy of Ophthalmology.