Menean Matteo, Sacconi Riccardo, Vujosevic Stela, Kesim Cem, Quarta Alberto, Ribarich Nicolò, Bottazzi Leonardo, Hilely Assaf, Capuano Vittorio, Souied Eric H, Sarraf David, Bandello Francesco, Querques Giuseppe
School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Ophthalmol Ther. 2023 Aug;12(4):2035-2048. doi: 10.1007/s40123-023-00727-8. Epub 2023 May 17.
In current clinical practice, several optical coherence tomography (OCT) biomarkers have been proposed for the assessment of severity and prognosis of different retinal diseases. Subretinal pseudocysts are subretinal cystoid spaces with hyperreflective borders and only a few single cases have been reported thus far. The aim of the study was to characterize and investigate this novel OCT finding, exploring its clinical outcome.
Patients were evaluated retrospectively across different centers. The inclusion criterion was the presence of subretinal cystoid space on OCT scans, regardless of concurrent retinal diseases. Baseline examination was set as the first time the subretinal pseudocyst was identified by OCT. Medical and ophthalmological histories were collected at baseline. OCT and OCT-angiography were performed at baseline and at each follow-up examination.
Twenty-eight eyes were included in the study and 31 subretinal pseudocysts were characterized. Out of 28 eyes, 16 were diagnosed with neovascular age-related macular degeneration (AMD), 7 with central serous chorioretinopathy, 4 with diabetic retinopathy, and 1 with angioid streaks. Subretinal and intraretinal fluid were present in 25 and 13 eyes, respectively. Mean distance of the subretinal pseudocyst from the fovea was 686 µm. The diameter of the pseudocyst was positively associated with the height of the subretinal fluid (r = 0.46; p = 0.018) and central macular thickness (r = 0.612; p = 0.001). At follow-up, subretinal pseudocysts disappeared in most of the reimaged eyes (16 out of 17). Of these, two patients presented retinal atrophy at baseline examination and eight patients (47%) developed retinal atrophy at follow-up. Conversely, seven eyes (41%) did not develop retinal atrophy.
Subretinal pseudocysts are precarious OCT findings, usually disclosed in a context of subretinal fluid, and are probably transient alterations within the photoreceptor outer segments and retinal pigment epithelium (RPE) layer. Despite their nature, subretinal pseudocysts have been associated with photoreceptor loss and incomplete RPE definition.
在当前临床实践中，已提出多种光学相干断层扫描（OCT）生物标志物用于评估不同视网膜疾病的严重程度和预后。视网膜下假性囊肿是具有高反射边界的视网膜下囊样间隙，迄今为止仅报道了少数单个病例。本研究的目的是对这一新型OCT表现进行特征描述和研究，探讨其临床结局。
对不同中心的患者进行回顾性评估。纳入标准为OCT扫描存在视网膜下囊样间隙，无论是否合并其他视网膜疾病。将首次通过OCT识别出视网膜下假性囊肿的时间设定为基线检查。在基线时收集患者的内科和眼科病史。在基线及每次随访检查时进行OCT和OCT血管造影检查。
本研究共纳入28只眼，对31个视网膜下假性囊肿进行了特征描述。28只眼中，16只被诊断为新生血管性年龄相关性黄斑变性（AMD），7只患有中心性浆液性脉络膜视网膜病变，4只患有糖尿病视网膜病变，1只患有血管样条纹。分别有25只和13只眼存在视网膜下液和视网膜内液。视网膜下假性囊肿距黄斑中心凹的平均距离为686μm。假性囊肿的直径与视网膜下液的高度（r = 0.46；p = 0.018）和中心黄斑厚度（r = 0.612；p = 0.001）呈正相关。随访时，大多数再次成像的眼中（17只中的16只）视网膜下假性囊肿消失。其中，2例患者在基线检查时出现视网膜萎缩，8例患者（47%）在随访时出现视网膜萎缩。相反，7只眼（41%）未发生视网膜萎缩。
视网膜下假性囊肿是不稳定的OCT表现，通常在视网膜下液的背景下出现，可能是光感受器外段和视网膜色素上皮（RPE）层内的短暂改变。尽管其性质如此，但视网膜下假性囊肿与光感受器丧失和RPE界定不清有关。
