Cystic maculopathy of the inner nuclear layer in glaucoma patients.

Purpose: The study aimed to detect and describe glaucoma-related pseudocystic abnormalities at the internal nuclear layer (INL) of the macula using OCT, in relation with visual field defects and other clinical data.
Patients and Methods: Primary open-angle glaucoma patients presenting for a follow-up visit were consecutively included over 5 months and underwent clinical examination, OCT imaging, and central 10-2 visual field testing. OCT measures included the thickness of the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC), together with an analysis of B-Scans and en-face images. All data provided by OCT were analyzed and compared with the visual field testing.
Results: Fourteen patients out of 216 showed pseudocysts in the INL of the macula. These cysts were hyporeflective, fusiform, and of variable size (15 to 25μm) and were always associated with a thinning of both the RNFL and GCC. En-face OCT showed evidence of a distribution of cysts in the macular region, based on the appearance of numerous, dense hyporeflective pits whose localization matched precisely with the vision loss as assessed by central 10-2 visual field testing. No other correlations were found.
Discussion: Pseudocysts of the internal nuclear layer of the macular region are found in some cases of chronic glaucoma. Their presence is always associated with a scotoma in the visual field and appear to constitute a marker for glaucoma progression. Glaucoma-related central pseudocysts could result from Müller cell changes, excitotoxicity, and/or trans-synaptic retrograde degeneration. The presence of pseudocysts could be a marker of a particular subpopulation whose features remain to be determined.
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