Apatient presented with a 3-year-plus history of treatment with anti-vascular endothelial growth factor (anti-VEGF) therapy for wet age-related macular degeneration (AMD), with no apparent improvement in anatomic morphology. Visual acuity was stable, but the patient continued to show persistent intraretinal cysts on timedomain Stratus (Carl Zeiss Meditec, Inc., Dublin, CA) optical coherence tomography (OCT; Figure 1) .
IMAGING AND OUTCOME
Spectral-domain optical coherence
tomography (SD-OCT) images
were acquired with the Cirrus HDOCT
4000 (Carl Zeiss Meditec, Inc.).
These images revealed that the areas
of persistent fluid were outer retinal
tubulation (Figure 2A). En face imaging
showed branching of the tubules
in the intraretinal space (Figure 2B).
As a result of our findings on SDOCT
imaging, the patient was
changed to less frequent anti-VEGF
therapy.
DISCUSSION
Outer retinal tubulation can
occur as a result of chronic fluid from wet AMD.1
These lesions can be mistaken for persistent intraretinal
cysts but are not responsive to anti-VEGF therapy.
SD-OCT imaging with Cirrus HD-OCT allowed us to
distinguish the outer retinal tubulation from blood
vessels, which resulted in a more appropriate course of
treatment.
David M. Brown, MD, FACS, is the director of the Greater Houston Retina Research Center and practices at Retina Consultants of Houston and the Methodist Hospital in Houston, TX. He is on the Retina Today Editorial Board. Dr. Brown states that he is a consultant for and receives clinical trial support from Alcon Laboratories, Inc., Allergan, Inc., Genentech, Novartis, and Regeneron; and receives clinical trial support from Pfizer, Inc., Targegen, Eli Lilly, GlaxoSmithKline, and Schering Plough. Dr. Brown can be reached at dmbmd@houstonretina.com.
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