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Anand Gandhi and Manish Nagpal
This healthy 43YO male presented with inferotemporal field loss in his right eye for 2 weeks. Vision was 20/20 OU.
Pseudocolor SLO imaging shows a superonasal macula-on rhegmatogenous retinal detachment (RRD) with two prominent retinal cysts.
OCT confirms the retinal detachment with cystic outer retinal fluid within the detachment and within the outer margin of a cyst. Emergent pars plana vitrectomy was scheduled.
Learning Points:
A retinal cyst is defined as a fluid-filled space in or derived from the retina, the diameter of which is greater than the thickness of the normal retina. They most commonly occur in chronic retinal detachments and have historically been described as retinal macrocysts (Liu et al, JAMA Ophthalmology 2018;136:956-958). The lining of these cavities localizes to the outer plexiform layer, indicating that the lesions result from intraretinal splitting rather than representing true cysts. In our experience, these cysts promptly resolve following retinal reattachment and therefore don’t need to be drained directly during retinal reattachment surgery.
Clin Exp Ophthalmol. 2026 Aug;54(6):796-811. doi: 10.1111/ceo.70128.
AMD hyperreflective foci are likely pigment-containing immune cells or possibly migrating RPE — Review.
Background: Hyperreflective foci identified on optical coherence tomography are promising biomarkers in age-related macular degeneration. However, their clinical application is limited by inconsistent definitions and ongoing uncertainty regarding their cellular origin. This review critically evaluates the evidence underlying hyperreflective foci definitions, examines competing hypotheses of cellular origin, and assesses their clinical utility.
Methods: A structured critical review was conducted using a systematic search of MEDLINE and Scopus in July 2025, identifying 164 publications reporting hyperreflective foci in age-related macular degeneration. Eligible studies included clinical imaging, clinicopathological, and histological investigations. Given substantial heterogeneity in study design and outcome measures, findings were synthesised interpretively across three domains: imaging definitions, cellular origin, and clinical associations.
Results: Clinical OCT definitions for hyperreflective foci were heterogeneous across studies. Histologically, hyperreflective foci correspond to pigment-laden epithelioid cells that consistently express monocyte/macrophage markers (CD68, CD163, IBA1) and lack retinal pigment epithelium markers (RPE65, peropsin). These cells are interpreted as pigment-containing macrophages that have ingested RPE-derived material, or as transdifferentiated RPE cells. Clinically, increasing hyperreflective foci burden is associated with disease severity, progression to geographic atrophy, and localised functional deficits, although associations with neovascular conversion and treatment response are inconsistent.
Conclusions: The available evidence suggests hyperreflective foci are pigment-containing immune cells, although altered or displaced retinal pigment epithelium cells may also be involved, and independent replication is required. Interpreting hyperreflective foci within this biological context may refine their role in disease monitoring and risk stratification. Establishing consensus imaging criteria, grounded in cellular identity, will be important for clinical translation.
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