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July 01, 2014; 83 (1) Article

Dynamic formation of macular microcysts independent of vitreous traction changes

Alexander U. Brandt, Timm Oberwahrenbrock, Ella Maria Kadas, Wolf A. Lagrèze, Friedemann Paul
First published May 23, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000545
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Abstract

Objective: To test the assumption of vitreous traction as a cause of macular microcysts in neuroinflammatory diseases and to establish a testable model to quantify vitreous traction changes.

Methods: Retrospective cohort study including 9 patients with neuroinflammatory diseases and macular microcysts that were longitudinally analyzed using optical coherence tomography. A mechanical model was developed to test the theory of vitreous traction vs macular swelling. This model was applied to one case presenting with dynamic microcyst evolution over 2 years with 4 visits.

Results: None of the patients' eyes with microcysts showed any signs of vitreous traction upon qualitative meticulous optical coherence tomographic analysis. The longitudinal changes analyzed in one patient were in the opposite direction as predicted by the mechanical model involving vitreous traction.

Conclusions: Vitreous traction does not appear to be a causative factor in macular microcyst formation. Quantitative analysis in one case shows even a reduced traction caused by an increase in macular thickness leading to vitreous impingement by the macular wall. The presented model might also serve as a quantification approach in other studies investigating macular microcysts.

GLOSSARY

CRION=
chronic relapsing inflammatory optic neuropathy;
INL=
inner nuclear layer;
MS=
multiple sclerosis;
NMO=
neuromyelitis optica;
OCT=
optical coherence tomography;
PVM=
posterior vitreous membrane

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at Neurology.org

  • Received September 16, 2013.
  • Accepted in final form February 26, 2014.
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Letters: Rapid online correspondence

  • Reply to Ziemssen & Ziemssen
    • Alexander U. Brandt, Head of Neurodiagnostics Laboratory, NeuroCure Clinical Research Center, Charité,Universitätsmedizin Berlin
    • Wolf A. Lagréze, University Eye Hospital, Freiburg, Germany
    Submitted July 30, 2014
  • Transient cystoid spaces of the retina in neuroinflammatory disease: progress towards knowledge?
    • Focke Ziemssen, Retina Specialist, University Eye Hospital Tuebingen, Eberhard-Karl university Tuebingen Germany
    • Tjalf Ziemssen, MS Center Dresden, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
    Submitted July 24, 2014
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