VITRECTOMY FOR STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS ASSOCIATED WITH OUTER RETINAL LAYER DEFECT

IS CATARACT SURGERY SAFE IN PATIENTS WITH STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS?

PURPOSE

To assess the retinal modifications after cataract surgery in a patient presenting with stellate nonhereditary idiopathic foveomacular retinoschisis.

METHODS

Retrospective analysis of the evolution of retinal status in a 64-year-old patient with unilateral stellate nonhereditary idiopathic foveomacular retinoschisis who underwent cataract surgery in the affected eye.

RESULTS

Visual acuity improved after surgery, reaching back the level described by the patient before the cataract onset, whereas fundus retinographies and optical coherence tomographies were stable at one month after surgery, compared with the preoperative images.

DISCUSSION

This first case-report of the evolution of stellate nonhereditary idiopathic foveomacular retinoschisis after cataract surgery suggests that this retinal condition is not modified by the surgical procedure, which however needs to confirmed by larger cohorts.

Stellate nonheritable idiopathic foveomacular retinoschisis in juveniles: case report

BACKGROUND

Stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) is a rare type of retinoschisis with a spoke-like splitting that occurs in the outer plexus layer. We present a case of stellate nonhereditary idiopathic foveomacular retinoschisis in a juvenile, in which two eyes show different development trends and macular retinoschisis could be associated with mechanical force in the Henle fibre layer. The removal of mechanical force can partially restore vision.

CASE PRESENTATION

A 14-year-old girl with bilateral SNIFR was diagnosed and followed up with spectral-domain optical coherence tomography (SD-OCT). During the two follow-up visits, vitreous adhesion was released in the left eye, and visual acuity improved. Neuroepithelial detachment was aggravated in the right eye, and visual acuity decreased. Therefore, vitrectomy was performed on the right eye. After surgery, the patient's retina was reattached, and her vision was partially restored.

CONCLUSIONS

We reported a juvenile with bilateral SNIFR. Each of her eyes showed different development trends, so we adopted different treatment methods for each eye. Vitrectomy was performed on the patient to address progressive vision loss, which improved the patient's vision. It was further confirmed that the Henle layer of SNIFR patients was susceptible to posterior vitreous membrane adhesion.

Bilateral Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis (SNIFR) Incidentally Identified in a Non-Myopic Female

Stellate foveomacular retinoschisis is commonly associated with congenital X-linked retinoschisis, which is almost exclusively seen bilaterally in males. In the absence of a family history of retinoschisis and other related conditions, the term stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) is used. SNIFR constitutes a rather rare diagnosis and is usually observed unilaterally in myopic females. Within this context, we report a case of a non-myopic female patient with bilateral SNIFR detected with optical coherence tomography (OCT).

STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS: NOVEL FINDINGS AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY ANALYSIS

PURPOSE

To present novel findings in stellate nonhereditary idiopathic foveomacular retinoschisis, including the largest series of optical coherence tomography angiography findings to date.

METHODS

A retrospective case series with multimodal imaging was obtained and reviewed.

RESULTS

All three patients were women, aged 59-63. Two cases were unilateral, and one was bilateral. Vision ranged from 20/20 to 20/60 in the affected eyes. Peripheral retinoschisis was observed in all three patients. All patients were followed for a minimum of 1 year. In one case, progressive macular retinoschisis leading to foveal involvement was observed over two years, with an associated vision decline from 20/25 to 20/60. Attempted interventions included topical dorzolamide in all cases and intravitreal bevacizumab in one patient; however, no treatment effect was observed. The foveal avascular zone size was within normal limits (mean 280 µ m). In all stellate nonhereditary idiopathic foveomacular retinoschisis eyes, the retinoschisis cavities were nonvascular.

CONCLUSION

Novel findings regarding stellate nonhereditary idiopathic foveomacular retinoschisis include the progressive nature of foveal involvement and the lack of response to topical dorzolamide and intravitreal bevacizumab. Foveal avascular zone was normal in all eyes, consistent with the relatively preserved vision in these cases. Retinoschisis cavities were nonvascular in all eyes, a finding which may give insight into the mechanism of this disease.

Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis: Cataract Surgery

Purpose

We present the first case described in the literature of cataract surgery in a patient with stellate nonhereditary idiopathic foveomacular retinoschisis (SNIF).

Methods

In this case report, we describe the extensive workup we did on our patient, including optical coherence tomography, fundus autofluorescence, fluo-angiography, full field electroretinogram, and genetic testing. We moreover describe the cataract surgery with clear lens extraction and implanting of a multifocal implant.

Results

The refractive and lifestyle profile of our patient made implantation of multifocal intraocular implants the only solution for this case. During preoperative measurements, a SNIF diagnosis was suspected after optic coherence tomography imaging which led to an even more extensive workup of our patient and the diagnosis of stellate nonhereditary idiopathic foveomacular retinoschisis. We then proceeded to cataract surgery, which was performed safely and without any sequellae.

Conclusion

Stellate nonhereditary idiopathic foveomacular retinoschisis (SNIF) is a relatively new disease entity. Only few cases in the literature describe this disease, and none of them describe cataract surgery in a patient with SNIF. We therefore describe the first known cataract surgery in such a case. Long term follow-up results show that the procedure can be performed safely. Summary Statement. We hereby present the first case described in the literature of cataract surgery of a patient diagnosed with stellate nonhereditary idiopathic foveomacular retinoschisis. A clear lens extraction with implantation of a multifocal intraocular implant was conducted with excellent postoperative results and a happy patient.

AN ASSOCIATION BETWEEN STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS, PERIPHERAL RETINOSCHISIS, AND POSTERIOR HYALOID ATTACHMENT

PURPOSE

Stellate nonhereditary idiopathic foveomacular retinoschisis is a disorder characterized by splitting of the retina at the macula, without a known underlying mechanical or inherited cause. This study investigates demographic, anatomical, and functional characteristics of subjects with stellate nonhereditary idiopathic foveomacular retinoschisis, to explore potential underlying mechanisms.

METHODS

In this single-site, retrospective, and cross-sectional, observational study, data were collected from 28 eyes from 24 subjects with stellate nonhereditary idiopathic foveomacular retinoschisis. Descriptive statistics were reported, based on the observed anatomico-functional features.

RESULTS

The visual acuity remained stable (median 20/20) in all subjects over a median follow-up of 17 months. All cases demonstrated foveomacular retinoschisis within Henle's fiber layer, at the junction of the outer plexiform and outer nuclear layers. This schisis cavity extended beyond the limits of the macular OCT temporally in all eyes. In most affected eyes, there were documented features of peripheral retinoschisis and broad attachment of the posterior hyaloid at the macula. Functional testing in a cross-sectional subset demonstrated normal retinal sensitivity centrally but an absolute scotoma peripherally.

CONCLUSION

Stellate nonhereditary idiopathic foveomacular retinoschisis seems to be associated with peripheral retinoschisis and anomalous or incomplete posterior hyaloid detachment. Despite chronic manifestation, this does not significantly affect central visual function but can manifest with profound loss of peripheral visual function.