“Doughnut appearance” of macular microcysts due to optic atrophy on optical coherence tomography angiography

PURPOSE: To describe the occurrence of optical coherence tomography (OCT) angiography features of microcysts in the macula due to optic atrophy. METHODS: A 63 year old male, with history of pituitary adenoma, was found to have disc pallor in his left eye and hyporeflective cysts in the inner nuclear layer (INL) at the macula on swept-source optical coherence tomography (OCT). The right eye was phthisical. Fundus fluorescein angiography and OCT angiography were performed to ascertain the cause. RESULTS: Fundus fluorescein angiography did not show any leakage, pointing to the diagnosis of microcystic macular edema (MME) due to optic neuropathy. OCT angiography and en face OCT demonstrated a striking pattern of the cysts in a circular distribution sparing the fovea at the level of the deep capillary plexus and INL respectively, giving it a "doughnut appearance". CONCLUSIONS: Optic neuropathy related MME demonstrates a typical pattern on OCT angiography that may help to distinguish this condition. SUMMARY: Optic neuropathy may result in microcysts in the macula that can be mistaken for macular edema. Non invasive optical coherence tomography angiography can show a prominent "doughnut" appearance that helps to characterise this entity and differentiate it from macular edema.