1
|
Ishida T, Kita Y, Itoh Y, Mizuno M, Hirota K, Koto T, Inoue M, Hirakata A. Optical coherence tomographic findings of glaucomatous eyes with papillomacular retinoschisis. Eye (Lond) 2024; 38:266-273. [PMID: 37524830 PMCID: PMC10811323 DOI: 10.1038/s41433-023-02671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/25/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES To investigate the relationship between the shape of the optic nerve head (ONH) margin detected by optical coherence tomography (OCT) and the clinical characteristics of glaucomatous eyes with papillomacular retinoschisis (PMRS). METHODS The medical record of patients with a PMRS in a glaucomatous eye were reviewed. The eyes were placed into two groups determined by the shape of the ONH margin in the OCT images; eyes with an externally oblique ONH margin (Group 1) and eyes with an internally oblique ONH margin (Group 2). We compared the clinical characteristics of the PMRS of these two groups. RESULTS We studied 31 eyes of 29 patients with PMRS and glaucoma with 24 eyes in Group 1 and 7 eyes in Group 2. The optic nerve fibre layer schisis on the lamina cribrosa (LC), beta zone, and gamma zone, and found that the LC defects were detected significantly more frequently in Group 1 than in Group 2 eyes (P < 0.05). A retinal nerve fibre schisis was observed around the ONH significantly more frequently in Group 2 than in Group 1 eyes (P < 0.01). CONCLUSION The cases of glaucoma-associated PMRS could be classified into two groups according to the obliquity of the ONH. They had differences in the findings of OCT and FA. The possibility that the mechanism of PMRS development is different in both groups is suggested.
Collapse
Affiliation(s)
- Tomoka Ishida
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan.
| | - Yoshiyuki Kita
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan
| | - Yuji Itoh
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan
| | - Masaharu Mizuno
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan
| | - Kazunari Hirota
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan
| | - Takashi Koto
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan
| | - Makoto Inoue
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan
| | - Akito Hirakata
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Fujimoto S, Kokame GT, Ryan EH, Johnson MW, Hirakata A, Shirriff A, Ishikawa H, Adams OE, Bommakanti N. Macular Retinoschisis from Optic Disc without a Visible Optic Pit or Advanced Glaucomatous Cupping (No Optic Pit Retinoschisis [NOPIR]). Ophthalmol Retina 2023; 7:811-818. [PMID: 37271192 DOI: 10.1016/j.oret.2023.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE To review eyes with peripapillary and macular retinoschisis without a visible optic pit or advanced glaucomatous optic atrophy, or No Optic Pit Retinoschisis (NOPIR). DESIGN Retrospective multicenter case series. SUBJECTS The study included 11 eyes of 11 patients. METHODS Retrospective study of eyes with macular retinoschisis without a visible optic pit, advanced optic nerve head cupping, or macular leakage on fluorescein angiography. MAIN OUTCOME MEASURES Visual acuity (VA), retinoschisis resolution, months to resolution, and recurrence of retinoschisis RESULTS: The mean age was 68.1 ± 17.6 years, mean intraocular pressure was 17.4 ± 3.8 mmHg, and the mean spherical equivalent refractive error was -3.1 ± 2.9 diopters. No subject had pathologic myopia. Seven subjects were treated for glaucoma, and 9 subjects had nerve fiber layer defects on OCT. All eyes had retinoschisis in the outer nuclear layer (ONL) in the nasal macula and extending to the edge of the optic disc, and 8 subjects had fovea-involving retinoschisis. Three nonfoveal and 4 fovea-involved eyes were observed, and 4 fovea-involved eyes with vision loss underwent surgery. Surgery involved preoperative juxtapapillary laser followed by vitrectomy and membrane and internal limiting membrane peeling with intraocular gas and face-down position. The mean baseline VA was significantly worse in the surgery group than that in the observation group (P = 0.020). Retinoschisis resolved and vision improved in all surgical cases. The mean resolution time for the surgery group was 2.75 ± 0.96 months, which was shorter than that for the observation group (28.0 ± 21.2 months; P = 0.014). No eye developed recurrence of the retinoschisis after surgery. CONCLUSIONS Peripapillary and macular retinoschisis can develop in eyes without a visible optic pit or advanced glaucomatous cupping. Eyes without foveal involvement and those with foveal involvement but only mild decrease in vision can be observed for spontaneous resolution. If there is persistent foveal involvement with vision loss, surgery can improve vision by resolving the macular retinoschisis. Surgery for fovea-involved macular retinoschisis without a visible optic pit resulted in faster anatomic resolution and better vision recovery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
| | - Gregg T Kokame
- Hawaii Macula and Retina Institute, Aiea, Hawaii; University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii.
| | | | - Mark W Johnson
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Akito Hirakata
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ashley Shirriff
- University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii
| | - Hiroshi Ishikawa
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | | | - Nikhil Bommakanti
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
3
|
Lama H, Pâques M, Brasnu E, Vu J, Chaumette C, Dupas B, Fardeau C, Chehaibou I, Rouland JF, Besombes G, Labetoulle M, Labbé A, Rousseau A. Severe macular complications in glaucoma: high-resolution multimodal imaging characteristics and review of the literature. BMC Ophthalmol 2023; 23:318. [PMID: 37452284 PMCID: PMC10347769 DOI: 10.1186/s12886-023-03068-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
PURPOSE To describe imaging characteristics of severe macular complications occurring in glaucoma and discuss available treatments. METHODS Retrospective case series of glaucomatous patients with macular retinoschisis (MR) and/or serous retinal detachment (SRD). Patients underwent a complete ophthalmological examination and multimodal imaging including retinography, SD-OCT, fluorescein and indocyanine green angiography (FA & ICGA) and adaptive optics (AO). RESULTS Ten eyes (8 patients) were included. Initial BCVA was 1.04 ± 1.12 logMAR and IOP was 24.0 ± 9.3mmHg. All eyes presented with MR while SRD was present in 5 eyes (5 patients), with a central macular thickness of 573 ± 152 μm. FA and ICGA allowed to exclude leakage in all cases. A focal lamina cribrosa defect (LCD) was found in four eyes (4 patients) using OCT, with AO providing en-face visualization of the defect in one eye. Outer retinal hole was present in 3 eyes (3 patients). No visual improvement or resolution of the macular retinoschisis was observed in eyes with medical or surgical IOP control (N = 9). Vitrectomy with internal membrane limiting peeling and gas tamponade was performed in one eye with good visual results. CONCLUSIONS Multimodal high-resolution imaging is essential to diagnose severe macular complications associated with advanced glaucoma.
Collapse
Affiliation(s)
- Hugo Lama
- Department of Ophthalmology, Assistance Publique - Hôpitaux de Paris - Université Paris Saclay, 78, rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France
| | - Michel Pâques
- Department of Ophthalmology, Quinze-Vingts National Eye Hospital, IHU Foresight, Paris, France
| | - Emmanuelle Brasnu
- Department of Ophthalmology, Quinze-Vingts National Eye Hospital, IHU Foresight, Paris, France
| | - Jade Vu
- Department of Ophthalmology, Assistance Publique - Hôpitaux de Paris - Université Paris Saclay, 78, rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France
- Ophtalmopôle Cochin, APHP, Paris, France
| | - Céline Chaumette
- Department of Ophthalmology, Quinze-Vingts National Eye Hospital, IHU Foresight, Paris, France
| | - Bénédicte Dupas
- Department of Ophthalmology, Assistance Publique - Hôpitaux de Paris - Université Paris Saclay, 78, rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France
| | - Christine Fardeau
- Department of Ophthalmology, Assistance Publique - Hôpitaux de Paris - Université Paris Saclay, 78, rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France
- Department of Ophthalmology, Pitié Salpétrière Hospital, APHP, Paris, France
| | | | | | | | - Marc Labetoulle
- Department of Ophthalmology, Assistance Publique - Hôpitaux de Paris - Université Paris Saclay, 78, rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France
| | - Antoine Labbé
- Department of Ophthalmology, Quinze-Vingts National Eye Hospital, IHU Foresight, Paris, France
| | - Antoine Rousseau
- Department of Ophthalmology, Assistance Publique - Hôpitaux de Paris - Université Paris Saclay, 78, rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France.
| |
Collapse
|
4
|
She X, Zhou C, Liang Z, Xie J, Zhao S, Tao J, Zhang Y, Mao J, Chen Y, Shen L. Hypodense regions in the peripapillary region increased the risk of macular retinoschisis detected by optical coherence tomography. Front Med (Lausanne) 2022; 9:1018580. [DOI: 10.3389/fmed.2022.1018580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
PurposeThe purpose of the present study was to investigate the clinical features of peripapillary regions in patients with myopic macular retinoschisis (MRS) and its association with the development of retinoschisis (RS).MethodsIn this cross-sectional study, high-myopic patients with or without MRS were recruited, and the hypodense regions were analyzed in the peripapillary regions. The vitreoretinal adhesions around both macular and paravascular arcades were compared between groups. The risk factors for the development of MRS were analyzed by logistic regression.ResultsOf 88 myopic eyes, MRS was detected in 45 eyes (51%). The eyes with MRS showed a higher rate of peripapillary and paravascular retinoschisis (P < 0.001 and P = 0.006). Hypodense regions were detected in 25 eyes (20.35%). Higher rates of horizontal and vertical macular MRS were detected in the hypodense group (P = 0.012 and P = 0.002). Lower refractive error, longer axial length, and higher rates of outer retinoschisis both in horizontal and vertical macular regions were observed in the hypodense group (P = 0.012, P = 0.006, P = 0.038, and P = 0.034). Higher rates of inner and outer retinoschisis, vitreoschisis, and microfolds along superior vascular arcade were detected in the hypodense group (P = 0.005, P = 0.001, P = 0.014, and P = 0.014). Higher rates of internal limiting membrane (ILM) detachment, inner and outer RS were detected along the inferior vascular arcade in the hypodense group (P = 0.008, P = 0.001, and P = 0.028). Hypodense regions, the axial length and PICC (peripapillary intrachoroidal cavitation) were significantly correlated with the severity of MRS (Odds ratio = 0.207, P = 0.010; Odds ratio = 1.399, P = 0.016; Odds ratio = 0.142, P = 0.010).ConclusionsThe hypodense regions were likely to affect outer retinoschisis both in macular and paravascular regions. It was a risk factor for the development of MRS.
Collapse
|
5
|
Aoki S, Imaizumi H. Vitrectomy for macular retinoschisis associated with peripapillary intrachoroidal cavitations in a moderately myopic eye. Int J Retina Vitreous 2022; 8:62. [PMID: 36064619 PMCID: PMC9446725 DOI: 10.1186/s40942-022-00409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background Peripapillary intrachoroidal cavitation (PICC), a cavernous change in the peripapillary choroid, may present with macular lesions. Here, we present a rare case of PICC with outer lamellar macular hole and macular retinoschisis. Case presentation A 69-year-old man presented with metamorphopsia in the left eye. Fundus examination revealed macular retinoschisis and PICCs. Pars plana vitrectomy with fovea sparing internal limiting membrane peeling (FSIP) was performed. Three weeks postoperatively, the patient developed rhegmatogenous retinal detachment and underwent a second vitrectomy. The macular retinoschisis resolved without macular hole formation and the patient’s visual acuity improved. There were no recurrent macular lesions over the three years of postoperative follow-up. Postoperative spectral-domain optical coherence tomography scan revealed a communication between the PICC and the vitreous cavity. Conclusions This case shed light on understanding development of PICC in non-highly myopic eyes and a rare complication of macular retinoschisis. Vitrectomy with FSIP may effectively resolve macular retinoschisis.
Collapse
Affiliation(s)
- Shuichiro Aoki
- Department of Ophthalmology, Sapporo City General Hospital, 13-1 Kita 11 West, Chuo-ku, Sapporo, 060-8604, Japan. .,Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hiroko Imaizumi
- Department of Ophthalmology, Sapporo City General Hospital, 13-1 Kita 11 West, Chuo-ku, Sapporo, 060-8604, Japan
| |
Collapse
|
6
|
Non-vasogenic cystoid maculopathies. Prog Retin Eye Res 2022; 91:101092. [PMID: 35927124 DOI: 10.1016/j.preteyeres.2022.101092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Besides cystoid macular edema due to a blood-retinal barrier breakdown, another type of macular cystoid spaces referred to as non-vasogenic cystoid maculopathies (NVCM) may be detected on optical coherence tomography but not on fluorescein angiography. Various causes may disrupt retinal cell cohesion or impair retinal pigment epithelium (RPE) and Müller cell functions in the maintenance of retinal dehydration, resulting in cystoid spaces formation. Tractional causes include vitreomacular traction, epiretinal membranes and myopic foveoschisis. Surgical treatment does not always allow cystoid space resorption. In inherited retinal dystrophies, cystoid spaces may be part of the disease as in X-linked retinoschisis or enhanced S-cone syndrome, or occur occasionally as in bestrophinopathies, retinitis pigmentosa and allied diseases, congenital microphthalmia, choroideremia, gyrate atrophy and Bietti crystalline dystrophy. In macular telangiectasia type 2, cystoid spaces and cavitations do not depend on the fluid leakage from telangiectasia. Various causes affecting RPE function may result in NVCM such as chronic central serous chorioretinopathy and paraneoplastic syndromes. Non-exudative age macular degeneration may also be complicated by intraretinal cystoid spaces in the absence of fluorescein leakage. In these diseases, cystoid spaces occur in a context of retinal cell loss. Various causes of optic atrophy, including open-angle glaucoma, result in microcystoid spaces in the inner nuclear layer due to a retrograde transsynaptic degeneration. Lastly, drug toxicity may also induce cystoid maculopathy. Identifying NVCM on multimodal imaging, including fluorescein angiography if needed, allows guiding the diagnosis of the causative disease and choosing adequate treatment when available.
Collapse
|
7
|
Machado Nogueira T, de Souza Costa D, Isenberg J, Rezende FA. Stellate nonhereditary idiopathic foveomacular retinoschisis resolution after vitreomacular adhesion release. Am J Ophthalmol Case Rep 2021; 23:101153. [PMID: 34195481 PMCID: PMC8237522 DOI: 10.1016/j.ajoc.2021.101153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/01/2020] [Accepted: 06/14/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To present a case of stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) resolution associated with vitreomacular adherence (VMA) release and propose a potential contributing association between SNIFR and vitreomacular interactions. OBSERVATIONS A 67-year-old female patient was diagnosed and followed for SNIFR in OD with spectral-domain optical coherence tomography (SD-OCT) scans at presentation and subsequent visits at 3, 6, 16 and 22 months. VMA and foveomacular retinoschisis remained unchanged on SD-OCT during the first 6 months of the follow-up. At 16-month follow-up visit, SD-OCT revealed VMA release and an important improvement of the macular schisis. At 22 months of follow-up, SNIFR cavities completely resolved in the presence of posterior hyaloid separation from the macular area without any adjunct treatment. The authors could not identify any other possible cause to justify the resolution of SNIFR other than VMA release in this case. Patient did not undergo any treatment for OD other than phacoemulsification 3 months after initial visit. CONCLUSION The present case illustrates with SD-OCT scans a possible association between SNIFR resolution and VMA release, highlighting a potential tractional component of the posterior vitreous on the internal limiting membrane and consequent glial cells stretching with schisis formation.
Collapse
Affiliation(s)
| | | | - Jordan Isenberg
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Flavio A. Rezende
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| |
Collapse
|
8
|
Sedaghat A, Sardarinia M, Abdi F, Anvari P, Parvaresh M, Falavarjani K. Optic pit-like maculopathy in a patient without any detectable disc anomalies. Saudi J Ophthalmol 2021; 35:149-151. [PMID: 35391803 PMCID: PMC8982937 DOI: 10.4103/1319-4534.337855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/02/2020] [Accepted: 12/13/2020] [Indexed: 11/04/2022] Open
|
9
|
Haruta M, Handa S, Yoshida S. Papillomacular retinoschisis associated with glaucoma: Response to topical carbonic anhydrase inhibitor. Am J Ophthalmol Case Rep 2020; 19:100741. [PMID: 32490282 PMCID: PMC7260430 DOI: 10.1016/j.ajoc.2020.100741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose Observations Conclusionsand Importance
Collapse
|
10
|
Case Report: Glaucoma-associated Peripapillary Retinoschisis with Corresponding Lamina Cribrosa Defect. Optom Vis Sci 2020; 97:104-109. [PMID: 32011583 DOI: 10.1097/opx.0000000000001474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Peripapillary retinoschisis is associated with primary and secondary glaucoma. It is important that clinicians are familiar with the presentation and management of peripapillary retinoschisis to understand its effects on the patient's glaucoma and to avoid unnecessary referral when the macula is not involved. PURPOSE We present a case of peripapillary retinoschisis found incidentally on routine optical coherence tomographic (OCT) surveillance of primary open-angle glaucoma. CASE REPORT A 70-year-old man presented for his annual diabetic eye examination. Surveillance with OCT revealed a splitting of the inner peripapillary retina corresponding to a previously noted notch in the right optic nerve. Further imaging of the right eye using enhanced depth imaging OCT revealed a defect in the lamina cribrosa that may have contributed to the formation and persistence of peripapillary retinoschisis. Retinal nerve fiber layer analysis showed a 5-year history of progressive temporal and inferotemporal thickening in the right eye. The patient was managed conservatively with instruction on regular Amsler grid testing. CONCLUSIONS As seen in this case, peripapillary retinoschisis typically alters retinal nerve fiber layer thickness on OCT and can be mistakenly attributed to glaucomatous change. Glaucoma-associated peripapillary retinoschisis is usually not vision threatening and can be managed conservatively; in rare cases of progression to macular involvement, patients should be referred to a retina specialist.
Collapse
|
11
|
Vitrectomy with peripapillary internal limiting membrane peeling for macular retinoschisis associated with normal-tension glaucoma. Am J Ophthalmol Case Rep 2020; 18:100663. [PMID: 32215342 PMCID: PMC7090242 DOI: 10.1016/j.ajoc.2020.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/05/2020] [Accepted: 03/07/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Although vitrectomy has been reported to be effective for the treatment of macular retinoschisis associated with glaucoma in a few case series, the surgical techniques have yet to be established. This article aimed to describe the cases of two patients with macular retinoschisis who underwent vitrectomy with peripapillary internal limiting membrane peeling around the defective area of the retinal nerve fiber layer. Observations Both patients had been diagnosed with normal tension glaucoma and treated with eye drops to stabilize intraocular pressure. Progression of macular retinoschisis and accompanied vision loss were observed in both cases. Twelve months after the surgery, both patients had resolution of the retinoschisis and improvement in best corrected visual acuity. Conclusions and importance Our surgical technique may be effective for the resolution of macular retinoschisis in eyes with normal tension glaucoma.
Collapse
|
12
|
Andreev AN, Shvaikin AV, Svetozarskiy SN. [Papillomacular retinoschisis associated with glaucoma]. Vestn Oftalmol 2020; 135:100-107. [PMID: 32015314 DOI: 10.17116/oftalma2019135061100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Peripapillary and macular retinoschisis is one of the rare manifestations of advanced glaucoma of different types. The article presents a case report and a mini-review. Peripapillary and macular retinoschisis with visual deterioration was diagnosed in a patient with advanced decompensated open-angle glaucoma and pseudoexfoliation syndrome. Surgical treatment of glaucoma led to intraocular pressure normalization, gradual regress of retinoschisis and improvement of visual functions. The retinal structure fully restored 1.5 years after the operation. The observation period was 3 years, retinoschisis did not recur. The article discusses the pathogenesis and potential algorithm for the treatment of the disease. Risk factors for the development of retinoschisis include high intraocular pressure, significant visual field defects and a wide range of diurnal intraocular pressure fluctuations. The source of the intra-retinal fluid is the vitreous body. Management of the patient consists of medical, laser and surgical normalization of intraocular pressure and regular monitoring. In case of persisting retinoschisis, patient undergoes vitreoretinal surgery or barrier laser coagulation. Retinal structure recovers gradually after the intervention and takes on average 1 year.
Collapse
Affiliation(s)
- A N Andreev
- Volga District Medical Centre, Federal Medical and Biological Agency, 2 Nizhnevolgskaya Naberejnaya, Nizhny Novgorod, Russian Federation, 603001
| | - A V Shvaikin
- Volga District Medical Centre, Federal Medical and Biological Agency, 2 Nizhnevolgskaya Naberejnaya, Nizhny Novgorod, Russian Federation, 603001
| | - S N Svetozarskiy
- Volga District Medical Centre, Federal Medical and Biological Agency, 2 Nizhnevolgskaya Naberejnaya, Nizhny Novgorod, Russian Federation, 603001
| |
Collapse
|
13
|
Fortune B, Ma KN, Gardiner SK, Demirel S, Mansberger SL. Peripapillary Retinoschisis in Glaucoma: Association With Progression and OCT Signs of Müller Cell Involvement. Invest Ophthalmol Vis Sci 2019; 59:2818-2827. [PMID: 29860466 PMCID: PMC5983909 DOI: 10.1167/iovs.18-24160] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose To examine demographic and clinical factors associated with glaucomatous peripapillary retinoschisis (PPRS) and assess its association with glaucoma progression. Methods Using a case control study design and longitudinal data from a cohort of 166 subjects with a diagnosis of glaucoma or glaucoma suspect, we compared functional, structural, clinical, and demographic characteristics between PPRS cases and controls. Results The frequency of PPRS was 6.0% (12 eyes from 10/166 subjects) with two eyes having PPRS in different sectors for a total of 15 retinoschisis events. There were no significant differences (P > 0.05) in age, sex, visual acuity, central corneal thickness, intraocular pressure, or presence of vitreous adhesion between PPRS and controls. However, eyes with PPRS tended to have a higher cup-to-disc ratio (P = 0.06), thinner RNFL (P = 0.02), and worse visual field mean deviation (MD, P = 0.06) than controls. The rate of RNFL thinning was faster in PPRS (average: −2.8%/year; range: −7.4% to 0.0%/year) than controls (−1.3%/year; range: −4.4% to 0.6%/year; P = 0.021). The rate of visual field MD change was faster in PPRS (−0.49 dB/year; range: −2.0 to 0.9 dB/year) than controls (−0.06 dB/year; range: −0.8 to 0.3 dB/year; P = 0.030). OCT scans showed hyperreflective structures spanning the PPRS whose morphology and spacing (50 ± 7 μm) are consistent with Müller glia, causing signal attenuation casting “shadows” onto distal retina. Conclusions This is the first report showing that glaucomatous PPRS is associated with a faster overall rate of RNFL thinning and visual field deterioration and to specifically identify OCT signs of Müller cell involvement.
Collapse
Affiliation(s)
- Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States
| | - Kelly N Ma
- Northwest Permanente, Portland, Oregon, United States
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States
| | - Shaban Demirel
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States
| | - Steven L Mansberger
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, Oregon, United States
| |
Collapse
|
14
|
Role of the Epipapillary Membrane in Maculopathy Associated with Cavitary Optic Disc Anomalies: Morphology, Surgical Outcomes, and Histopathology. J Ophthalmol 2018; 2018:5680503. [PMID: 29854427 PMCID: PMC5964424 DOI: 10.1155/2018/5680503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/15/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the surgical outcomes of pars plana vitrectomy (PPV) with epipapillary membrane removal in patients with maculopathy associated with cavitary optic disc anomalies. Methods Eight patients (8 eyes) with cavitary optic disc anomaly-associated maculopathy who underwent PPV with epipapillary membrane removal were retrospectively reviewed. The best-corrected visual acuity (BCVA) and macular and papillary morphologies using enhanced depth imaging optical coherence tomography (EDI-OCT) were evaluated before and after treatment. Immunohistochemistry for an intraoperatively excised epipapillary membrane tissue was also performed. Results Before surgery, EDI-OCT revealed that epipapillary membrane was observed in all patients. Retinoschisis was resolved with no recurrence in all patients following vitrectomy regardless of a disease type or the presence or absence of preoperative posterior vitreous detachment. The mean final BCVA and central retinal thickness significantly improved compared with pretreatment values (P = 0.008 and 0.004, resp.). Immunoreactivity for S100 protein and glial fibrillary acidic protein, markers of astrocytes, was positive in the resected membrane tissues. Conclusions These results suggest that epipapillary membrane is involved in the pathogenesis of some patients with cavitary optic disc anomaly-associated maculopathy as well as posterior hyaloid membrane. PPV with epipapillary membrane removal may be a useful treatment option for this maculopathy. This trial is registered with UMIN000011123.
Collapse
|
15
|
Yoshikawa T, Yamanaka C, Kinoshita T, Morikawa S, Ogata N. Macular retinoschisis in eyes with glaucomatous optic neuropathy: Vitrectomy and natural course. Graefes Arch Clin Exp Ophthalmol 2017; 256:281-288. [PMID: 29164327 DOI: 10.1007/s00417-017-3855-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/23/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Our purpose was to determine the effectiveness of vitrectomy in resolving the macular retinoschisis in an eye with glaucomatous optic neuropathy and also to determine the natural course of macular retinoschisis. METHODS This was a retrospective case series of patients who were diagnosed with macular retinoschisis and glaucomatous optic neuropathy. Fourteen eyes of 13 patients were studied. Patients with high myopia, vitreomacular traction syndrome, and the pit macular syndrome were excluded. RESULTS There were three men and ten women, and 12 had unilateral and one had bilateral macular retinoschisis. Vitrectomy was performed for a serous retinal detachment, macular hole, or severe visual loss in five eyes. The mean follow-up time was 68.8 months in these five eyes, and the macular retinoschisis was resolved and the best-corrected visual acuity (BCVA) at the final visit was significantly improved in all eyes (P = 0.007). However, two of these fiv e eyes developed a macular hole and required a second vitrectomy. Of the nine eyes without treatment with a mean follow-up time of 29.0 months, the BCVA at the final visit remained unchanged from the baseline BCVA in all eyes. The macular retinoschisis was resolved or reduced in three eyes without treatment. CONCLUSIONS Vitrectomy was effective for the resolution of macular retinoschisis in eyes with glaucomatous optic neuropathy and serous retinal detachment or macular hole or severe reduction of the BCVA. Macular retinoschisis can be resolved without a reduction of the BCVA in some cases without treatment.
Collapse
Affiliation(s)
- Tadanobu Yoshikawa
- Department of Ophthalmology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Chihiro Yamanaka
- Department of Ophthalmology, Tokushima University School of Medicine, Tokushima, Japan
| | - Takamasa Kinoshita
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Shohei Morikawa
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| |
Collapse
|
16
|
Abstract
PURPOSE To evaluate the efficacy of vitrectomy in the treatment of macular retinoschisis without a detectable optic disk pit. METHODS This retrospective interventional case series included eight patients with acquired, unilateral macular retinoschisis with or without foveal detachment. Patients with an optic disk pit, vitreomacular traction, or high myopia were excluded. Six of the eight patients underwent vitrectomy with internal limiting membrane peeling and fluid-air exchange. The surgical outcome was evaluated in terms of the improvement in the macular anatomy and the best-corrected visual acuity. RESULTS During vitrectomy, all the six eyes were confirmed to have preexisting posterior vitreous detachment. Macular retinoschisis was resolved or reduced in all the six eyes after vitrectomy. The mean central foveal thickness showed significant improvement at the time of the patient's final visit after vitrectomy. The mean best-corrected visual acuity was 20/52 before surgery and 20/31 at the final visit. CONCLUSION Vitrectomy might be effective for the treatment of macular retinoschisis without an optic disk pit. Although clinically similar to optic pit maculopathy except for the absence of pit, our intraoperative observations of the posterior hyaloid membrane suggest that maculopathy without optic disk pit has a distinct pathogenesis.
Collapse
|
17
|
Dhingra N, Manoharan R, Gill S, Nagar M. Peripapillary schisis in open-angle glaucoma. Eye (Lond) 2016; 31:499-502. [PMID: 27834967 DOI: 10.1038/eye.2016.235] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/22/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo report clinical features, topographic findings and outcome of 10 eyes with peripapillary schisis in open-angle glaucoma.Patients and methodsA retrospective review of patients with open-angle glaucoma who were noted to have peripapillary schisis on optical coherence tomography (OCT) were included. Serial peripapillary and macula infrared and OCT images, visual acuity, visual fields, and schisis appearance were reviewed.ResultsTen eyes of nine patients with open-angle glaucoma were detected to have the presence of peripapillary schisis. Nerve fibre layer schisis was detected in all eyes and one eye had an associated macular schisis. None of the eyes had an acquired pit of the optic nerve or pathological myopia. The mean intraocular pressures at detection was 18.3±4.3 mm Hg and the schisis resolved in four eyes after a mean follow-up of 21.2±8.8 months. Visual field worsening was noted in 4 of the 10 eyes and the resolution of schisis resulted in significant reduction in the retinal nerve fibre layer (RNFL) thickness.ConclusionsPeripapillary schisis detected during the normal course of open-angle glaucoma can resolve spontaneously and rarely involves the macula. Its resolution leads to reduction in RNFL thickness; therefore, caution is advised while interpreting serial scans.
Collapse
Affiliation(s)
- N Dhingra
- Pinderfields Hospital, Mid Yorkshire NHS Trust, Wakefield, UK
| | - R Manoharan
- Pinderfields Hospital, Mid Yorkshire NHS Trust, Wakefield, UK
| | - S Gill
- Pinderfields Hospital, Mid Yorkshire NHS Trust, Wakefield, UK
| | - M Nagar
- Pinderfields Hospital, Mid Yorkshire NHS Trust, Wakefield, UK
| |
Collapse
|
18
|
Abstract
PURPOSE To describe the clinical features of idiopathic foveomacular retinoschisis not in association with myopia, glaucoma, optic disk pit, or juvenile retinoschisis. METHODS Retrospective observational case series. Five eyes of five patients with idiopathic foveomacular retinoschisis were included. RESULTS The patients were 2 men and 3 women (average age, 75.2 years; range, 71-78 years). The average spherical equivalent was +2.40 diopters (range, +0.88 to +5.75 diopters), and the average axial length was 22.0 mm (range, 21.1-23.1 mm). All patients had retinoschisis from the macula to the optic disk in the affected eye. No patients had retinoschisis in the fellow eye. The average best-corrected visual acuity was 20/44 (68 Early Treatment Diabetic Retinopathy Study letter score). CONCLUSION Idiopathic foveomacular retinoschisis is not inherited or associated with myopia, vitreomacular traction syndrome, optic pit, or glaucoma but is associated with older age, unilaterality, hyperopia with short axial length, complete posterior vitreous detachment, and weak leakage from the optic disk on fluorescein angiography.
Collapse
|