Retinal Pseudocysts in Age-Related Geographic Atrophy

PURPOSE: To report the presence of pseudocysts in retinal layers of eyes with geographic atrophy (GA) attributable to age-related macular degeneration (AMD) and to estimate their prevalence. DESIGN: Retrospective study. METHODS: SETTING: Clinical practice. PATIENTS: Consecutive patients with GA, assessed by spectral-domain optical coherence tomography (OCT). MAIN OUTCOME MEASURES: Assessment of pseudocyst prevalence in retinal layers. Statistical analysis by the chi(2) test, Fisher exact test, Mann-Whitney U test, and Cramer test, performed to explore links between the presence of pseudocysts and demographic features and/or pattern of atrophy, ie, horseshoe, homogeneous area, homogeneous area or patchy atrophy with foveal sparing, and patchy atrophy. RESULTS: Eighty-eight eyes of 68 GA patients aged between 61 and 94 years (mean: 79.8) were examined. In 20 patients, GA was bilateral. Twenty-four eyes (27.2%) exhibited pseudocysts corresponding to small cystoid spaces frequently located in the inner nuclear layer of the retina. There was no macular edema. Fluorescein angiography, performed in 71 eyes (80%), ruled out possible choroidal neovascularization. No correlation was found between 1) patients' age (P = .7) or gender (P > .99) and the presence of pseudocysts or 2) patterns of atrophy (Cramer test: V = 0.183) and the presence of pseudocysts. CONCLUSIONS: Pseudocysts seemed to be frequent in atrophic AMD. They might correspond to Muller cell degeneration, as suspected in other degenerative retinal disorders like tamoxifen retinopathy or group 2A idiopathic juxtafoveolar retinal telangiectasis. The present results indicate that pseudocysts are frequently seen on OCT in eyes with atrophic AMD and their presence should not be considered as a manifestation of neovascular AMD that requires prompt treatment. (Am J Ophthalmol 2010;150:211-217. (C) 2010 by Elsevier Inc. All rights reserved.)