DOI: 10.1097/IAE.0000000000000419

,  

,  

PMID: 25621946

Issn Print: 0275-004X

Publication Date: 2015/06/01


Print

Moment of Cyst Eruption Captured by Optical Coherence Tomography in Diabetic Macular Edema

Jong-Hyun Oh; Jaeryung Oh

+ Author Information

Author Information: Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, South Korea; and

    loading  Checking for direct PDF access through Ovid

Excerpt

Gass1 suggested that the structural changes that occur when the inner wall of a large cystoid space in cystoid macular edema ruptures lead to formation of a lamellar macular hole (LMH). In addition to the traction associated with the epiretinal membrane or the posterior hyaloid membrane, increased internal pressure within the cystoid space has been suggested as a contributing factor in LMH formation.2 Directly observing a rupturing cyst would be helpful in understanding the pathogenesis of LMH formation.
A 52-year-old woman received 3 sub-Tenon's injections of triamcinolone acetonide and 8 intravitreal injections of bevacizumab in her left eye for treatment of diabetic cystoid macular edema. Despite these procedures, cystoid macular edema did not resolve completely; her best-corrected visual acuity was 20/50, and central subfield retinal thickness was 431 μm (Figure 1, A and B). One month after the ninth intravitreal injection of bevacizumab, intraretinal fluid eruption into the vitreous cavity through an inner wall defect in the cystoid space was noted on optical coherence tomography (Figure 1C; see Video, Supplemental Digital Content 1, http://links.lww.com/IAE/A320). Lamellar macular hole was found on optical coherence tomography examination the next month (Figure 1D).
In an eye with diabetic cystoid macular edema, the moment of cyst eruption was incidentally captured by three-dimensional optical coherence tomography imaging. Optical coherence tomography images showed the cyst erupting into the vitreous cavity, much like the eruption of a volcano. The height of the eruption column reached 355 μm. Although we were not able to calculate the pressure difference between the cystic cavity and the vitreous cavity, this image may support the idea that increased internal pressure is partially responsible for ruptures in the inner wall of the cystoid space and resulting formation of LMHs.2 However, there was no deformation of the cyst contour, which could be considered as an additional finding of increased internal pressure. There was no complete posterior vitreous detachment, and a tractional mechanism could not be ruled out in our case. In addition, the role of bevacizumab in transforming a cystoid space into an LMH remains unclear.
    loading  Loading Related Articles