Microcystic Macular Changes in Primary Open-angle Glaucoma.
Wen Joanne C, Freedman Sharon F, El-Dairi Mays A, Asrani Sanjay
AI Summary
This study found young, African American males with advanced glaucoma can have inner nuclear layer microcysts, making their macula appear normal despite nerve damage, potentially confounding glaucoma diagnosis.
Abstract
Purpose
To describe microcystic macular changes in patients with moderate to advanced primary open-angle glaucoma.
Patients and methods: Eleven eyes of 6 unrelated patients were retrospectively identified based on a disproportionately preserved macular thickness on optical coherence tomography (OCT) despite severe peripapillary retinal nerve fiber layer thinning. Patient demographic, history, and examination findings were reviewed.
Results
All identified patients were African American, relatively young (mean age, 43.8 y) and 5 of the 6 patients were males. Examination of individual macular OCT sections through areas of disproportionately preserved macular thickness invariably demonstrated numerous small cystic cavities within the inner nuclear layer. These microcystic changes were seen in areas of the macula that corresponded with areas of glaucoma-related ganglion cell loss, therefore mimicking the normal appearance of retinal thickness in the macular region. No other retinal pathologies were identified on the macular OCT to account for these changes.
Conclusions
This study describes microcystic macular changes in mostly young, African American males with moderate to advanced primary open-angle glaucoma. Vitreous adherence to the internal limiting membrane preventing retinal collapse is a proposed mechanism. The disproportionately preserved macular volume may confound the diagnosis of glaucoma in these patients.
MeSH Terms
Shields Classification
Key Concepts6
Microcystic macular changes were observed in 11 eyes of 6 unrelated patients with moderate to advanced primary open-angle glaucoma, who were identified based on disproportionately preserved macular thickness on optical coherence tomography despite severe peripapillary retinal nerve fiber layer thinning.
All identified patients with microcystic macular changes in moderate to advanced primary open-angle glaucoma were African American, relatively young (mean age, 43.8 years), and 5 of the 6 patients were male.
Examination of individual macular OCT sections in patients with microcystic macular changes and primary open-angle glaucoma demonstrated numerous small cystic cavities within the inner nuclear layer in areas of disproportionately preserved macular thickness.
The microcystic changes in patients with primary open-angle glaucoma were seen in areas of the macula that corresponded with areas of glaucoma-related ganglion cell loss, mimicking the normal appearance of retinal thickness in the macular region.
No other retinal pathologies were identified on macular OCT to account for the microcystic changes in patients with moderate to advanced primary open-angle glaucoma.
Vitreous adherence to the internal limiting membrane preventing retinal collapse is a proposed mechanism for the microcystic macular changes observed in mostly young, African American males with moderate to advanced primary open-angle glaucoma.
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