Foveal cysts - A premacular hole condition associated with vitreous traction

Objective: To define the clinical findings, cause, and outcome of patients with foveal cysts due to vitreous traction. Methods: Follow-up of 18 patients with foveal cysts and no posterior vitreous detachment (PVD). Changes were documented in visual acuity, the appearance of the fovea, or the development of a macular hole or PVD. We studied 8 eyes using the retinal thickness analyzer. Results: On follow-up, 9 of 23 eyes did not develop a PVD and still had a foveal cyst; 8 of 23 developed a full-thickness macular hole; 4 of 23 developed a PVD with resolution of the cyst; and 23 eyes underwent vitrectomy for the cyst before a full-thickness hole developed. Analysis with the retinal thickness analyzer showed splitting within the middle retinal layers and in some cases unroofing or absent inner retinal layers in the center of the cyst. Conclusions: Foveal cysts are caused by vitreous traction. These eyes may remain stable, develop full-thickness holes, or develop a PVD with resolution of the cystic changes. A foveal cyst seems to be a common finding in patients with foveal traction from a variety of mechanisms.