Distinctive Mechanisms and Patterns of Exudative Versus Tractional Intraretinal Cystoid Spaces as Seen With Multimodal Imaging

• Published in: American journal of ophthalmology Vol. 212; pp. 43 - 56
• Main Authors: Govetto, Andrea, Sarraf, David, Hubschman, Jean-Pierre, Tadayoni, Ramin, Couturier, Aude, Chehaibou, Ismael, Au, Adrian, Grondin, Christelle, Virgili, Gianni, Romano, Mario R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2020; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Automation; Cataracts; Diabetes; Diabetic retinopathy; Diabetic Retinopathy - diagnostic imaging; Diabetic Retinopathy - pathology; Edema; Female; Fluorescein Angiography - methods; Fundus Oculi; Hospitals; Humans; Macular degeneration; Macular Edema - diagnostic imaging; Macular Edema - pathology; Male; Medical imaging; Middle Aged; Morphology; Multimodal Imaging - methods; Optical Imaging - methods; Pathophysiology; Patients; Retina - diagnostic imaging; Retina - pathology; Retrospective Studies; Software; Tomography, Optical Coherence - methods; Los Angeles California; Italy; California; United States > US
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2019.12.010

To determine clear-cut distinctions between tractional and exudative intraretinal cystoid spaces subtypes. Retrospective, multicenter, observational case series. A cohort of patients diagnosed with intraretinal cystoid spaces and imaged with optical coherence tomography (OCT), fluorescein angiography (FA), blue fundus autofluorescence (BFAF), en face OCT, and OCT angiography (OCT-A) was included in the study. All images were qualitatively and quantitatively evaluated. In this study were included 72 eyes of 69 patients. Exudative intraretinal cystoid spaces (36/72 eyes, 50%) displayed a “petaloid” morphology as seen with en face OCT, FA, and BFAF. Tractional intraretinal cystoid spaces (24/72 eyes, 33.3%), displayed a radial “spoke-wheel” en face OCT pattern. There was no leakage with FA and BFAF did not reveal specific patterns. Eyes with full-thickness macular hole (FTMH, 12/72 eyes, 16.7%) displayed a “sunflower” en face OCT appearance. FTMH showed OCT, OCT-A, and BFAF features of both exudative and tractional cystoid spaces, but without any FA leakage. Inner nuclear layer (INL) thickness was significantly lower in tractional cystoid spaces (P < .001). There were a greater number of INL cystoid spaces in both the exudative and FTMH subgroups (P = .001). The surface area of INL cystoid spaces was significantly lower in the tractional subgroup (P < .001). There was a significant reduction of the microvascular density in eyes with exudative vs tractional (P = .002) and FTMH (P < .001) subgroups. Exudative and tractional intraretinal cystoid spaces displayed characteristic multimodal imaging features and they may represent 2 different pathologic conditions with equally different clinical implications. •Tractional and exudative intraretinal cystoid spaces exhibit distinctive features with multimodal imaging.•Exudative cystoid spaces display a petaloid pattern with en face optical coherence tomography (OCT) imaging.•Tractional cystoid spaces display a spoke-wheel pattern with en face OCT imaging.•Full-thickness macular hole exhibits features common to both tractional and exudative subtypes.•Dye-based techniques maintain a key role in the distinction between intraretinal cystoid spaces subtypes.