Distinctive Mechanisms and Patterns of Exudative Versus Tractional Intraretinal Cystoid Spaces as Seen With Multimodal Imaging

Andrea Govetto*, David Sarraf, Jean Pierre Hubschman, Ramin Tadayoni, Aude Couturier, Ismael Chehaibou, Adrian Au, Christelle Grondin, Gianni Virgili, Mario R. Romano

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


Purpose: To determine clear-cut distinctions between tractional and exudative intraretinal cystoid spaces subtypes. Design: Retrospective, multicenter, observational case series. Methods: A cohort of patients diagnosed with intraretinal cystoid spaces and imaged with optical coherence tomography (OCT), fluorescein angiography (FA), blue fundus autofluorescence (BFAF), en face OCT, and OCT angiography (OCT-A) was included in the study. All images were qualitatively and quantitatively evaluated. Results: In this study were included 72 eyes of 69 patients. Exudative intraretinal cystoid spaces (36/72 eyes, 50%) displayed a “petaloid” morphology as seen with en face OCT, FA, and BFAF. Tractional intraretinal cystoid spaces (24/72 eyes, 33.3%), displayed a radial “spoke-wheel” en face OCT pattern. There was no leakage with FA and BFAF did not reveal specific patterns. Eyes with full-thickness macular hole (FTMH, 12/72 eyes, 16.7%) displayed a “sunflower” en face OCT appearance. FTMH showed OCT, OCT-A, and BFAF features of both exudative and tractional cystoid spaces, but without any FA leakage. Inner nuclear layer (INL) thickness was significantly lower in tractional cystoid spaces (P < .001). There were a greater number of INL cystoid spaces in both the exudative and FTMH subgroups (P = .001). The surface area of INL cystoid spaces was significantly lower in the tractional subgroup (P < .001). There was a significant reduction of the microvascular density in eyes with exudative vs tractional (P = .002) and FTMH (P < .001) subgroups. Conclusions: Exudative and tractional intraretinal cystoid spaces displayed characteristic multimodal imaging features and they may represent 2 different pathologic conditions with equally different clinical implications.

Original languageEnglish
Pages (from-to)43-56
Number of pages14
JournalAmerican Journal of Ophthalmology
Early online date17 Dec 2019
Publication statusPublished - Apr 2020
Externally publishedYes

Bibliographical note

Funding Information:
Funding/Support: This study was supported by unrestricted grants on publications from the Research to Prevent Blindness Foundation (RPB, New York, New York, USA) and from the Hess Foundation (Roseland, New Jersey, USA). Financial Disclosures: Andrea Govetto: None; Jean Pierre Hubschman: consultant for Alcon (Fort Worth, Texas, USA), Allergan (Dublin, Ireland), Bausch and Lomb (Rochester, New York, USA), Novartis (Basel, Switzerland), and Zeiss (Oberkochen, Germany); David Sarraf: consultant for Amgen (Thousand Oaks, California, USA), consultant and speaker for Bayer (Leverkusen, Germany), consultant and researcher for Genentech (San Francisco, California, USA), researcher for Heidelberg (Heidelberg, Germany), speaker for Novartis (Basel, Switzerland), consultant, researcher, and speaker for Optovue (Fremont, California, USA), researcher for Regeneron (Tarrytown, New York, USA); Ramin Tadayoni: Personal fees–Novartis (Basel, Switzerland), Bayer (Leverkusen, Germany), Roche (Basel, Switzerland), Genentech (San Francisco, California, USA), Allergan (Dublin, Ireland), Zeiss (Oberkochen, Germany), Alcon (Fort Worth, Texas, USA); Aude Couturier: Personal fees–Allergan (Dublin, Ireland), Bayer (Leverkusen, Germany), Novartis (Basel, Switzerland); Ismael Chehaibou: None; Adrian Au: None; Christelle Grondin: None; Gianni Virgili: None; Mario R. Romano: research grants from Alcon (Fort Worth, Texas, USA); DORC (Zuidland, Holland); Bausch & Lomb (Rochester, New York, USA); Bayer (Leverkusen, Germany), consultant for Leica (Wetzlar, Germany). All authors attest that they meet the current ICMJE criteria for authorship.

Publisher Copyright:
© 2019 Elsevier Inc.

Copyright 2020 Elsevier B.V., All rights reserved.

ASJC Scopus subject areas

  • Ophthalmology


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