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This report describes a 19-year-old patient with the rare association of macular retinoschisis and outer retinal hole formation with papillorenal syndrome. Initially diagnosed with transplant-related central serous chorioretinopathy, she presented several years later with worsening vision and distortion in her right eye. On examination, she was found to have bilateral optic nerve dysplasia, bilateral macular and extramacular retinoschisis, and a serous retinal detachment with outer hole formation in the right eye. A history of prior renal transplantation due to poor kidney development led to the diagnosis of papillorenal syndrome., (Copyright 2015, SLACK Incorporated.)

The author reports a case of a 16-year-old boy with decreased vision secondary to optic pit maculopathy. Clinical examination revealed two distinct optic pits in the optic nerve head with macular schisis and no subretinal fluid. Follow-up examination at 1 year demonstrated stable macular schisis and vision. This case illustrates visual impairment secondary to optic pit maculopathy arising from two optic pits in a single optic nerve head., (Copyright 2015, SLACK Incorporated.)

Purpose: To report the first case of branch retinal artery occlusion (BRAO) following surgical excision of orbital cavernous hemangioma., Methods: A 34-year-old man was referred to our department with an orbital cavernous hemangioma compressing the optic nerve, the medial rectus muscle, and the eyeball, and resulting in a hyperemic optic disc, vascular tortuosity, and pronounced choroidal folds at fundus biomicroscopy. The patient underwent transconjunctival inferior orbitotomy and the lesion was excised entirely without intraoperative complications., Results: On the second postoperative day, best-corrected visual acuity (BCVA) decreased from 2/10 to counting fingers and fundus examination showed occlusion of the inferotemporal branch retinal artery. Fluorescein angiography and spectral-domain optical coherence tomography (SD-OCT) confirmed the diagnosis. One month of corticosteroid therapy and anticoagulation therapy were prescribed. The patient was followed up for 6 months; SD-OCT showed resolution of the retinal thickening and the retinoschisis but a new hyporeflective space in the outer retina at the fovea had appeared at 6 months follow-up. The patient's BCVA improved to 9/10 after 6 months but an absolute superior visual field defect was still present at the end of the follow-up., Conclusions: We describe the first reported case of BRAO following orbital cavernous hemangioma excision with significant improvement of the BCVA at 6-month follow-up. The SD-OCT could be a useful tool to monitor morphologic changes of the area corresponding to the retinal ischemia.

Purpose: To investigate the long-term results of a novel technique to preserve the foveolar cone without peeling off the foveolar internal limiting membrane (ILM) during myopic traction maculopathy surgery., Methods: Nineteen patients (19 eyes) were retrospectively studied and divided into 2 groups by the extent of ILM peeled and followed for more than 3 years. Group 1: foveolar ILM nonpeeling group (FN) (12 eyes) and Group 2: total peeling of foveal ILM group (TP) (7 eyes). A donut-shaped ILM was peeled off, leaving a 400-μm diameter ILM over foveola with a sharp margin in FN group., Results: Macular hole was developed in 2 of the 7 eyes (28.6%) in the TP group and none in the FN group. Long-term central fovea thickness thinning and decrease of vision were found in the TP group, but not in the FN group (P < 0.05). Inner segment/outer segment line recovered in 75% of the 12 eyes in the FN group, but in only 14.3% of the 7 eyes in the TP group., Conclusion: Preservation of the foveolar cone by foveola nonpeeling surgery correlates with better anatomical and visual results than total peel, prevents long-term foveolar retinal thinning, and successfully saves the fovea from macular hole formation.

Purpose: We report here a patient with bilateral papillomacular retinoschisis with an enlarged glaucomatous optic nerve head cup and a focal lamina cribrosa defect, the findings of our clinical investigations of this case, and the chosen treatment and outcome., Design: This is an observational case report., Methods: Clinical examinations were performed using simultaneous confocal scanning laser ophthalmoscopy and optical coherence tomography (OCT). The patient was treated by pars plana vitrectomy (PPV)., Results: The left eye had a macular detachment with a presumed acquired pit of the optic nerve, while the right eye did not have an obvious optic nerve pit. Enhanced depth imaging OCT showed focal lamina cribrosa defects in both eyes. PPV was performed on the left eye, which resulted in a re-attachment of the macula and improvement of the visual acuity., Conclusions: Our findings suggest that the pathological changes were most likely due to focal lamina cribrosa defects in both glaucomatous eyes. This type of maculopathy can be successfully treated with PPV.

Background: Posterior microphthalmos combined with acquired retinoschisis is a rare entity. This report presents a case of acquired retinoschisis in a patient with posterior microphthalmos and discusses the management for such disease. The patient exhibited acquired peripheral retinal schisis in both eyes., Case Presentation: The patient presented with a fix scotoma and decrease in visual acuity for 2 weeks in his left eye. Ocular examination revealed that his best-corrected visual acuity was 0.6 in right eye and 0.2 in left eye. The patient had amblyopia because of hyperopia with spherical equivalent of +11.75 diopters in the right eye and +12.00 diopters in the left eye. The axial lengths were 18.41 mm in right and 18.43 mm in left eyes respectively. Slip lamp examination found normal anterior segments. Funduscopy showed bilateral retinoschisis in inferotemporal retina. The schisis in right eye was limited to peripheral retina whereas the schisis in left eye was bullous type. The schisis in the left eye extended from the periphery to the posterior macular region in left eye. A pars plana vitrectomy was performed in the left eye and visual acuity was restored to 0.6., Conclusion: Posterior microphthalmos combined with retinoschisis is rare. When it appears in peripheral retina, the schisis remains stable. In cases where the schisis extends to posterior pole and affects the macula, surgery in the form of pars plana vitrectomy could be an option.

Purpose: To investigate factors associated with myopic foveoschisis and macular bending and to determine how the presence of macular bending affects the development of myopic foveoschisis., Methods: In a prospective study of 194 eyes of 105 patients with high myopia, we performed complete ophthalmic examinations, optical coherence tomography (OCT), and A-scan ultrasounds. Patients were divided into three groups according to the OCT results. Group 1 consisted of 25 eyes (17 patients) with myopic foveoschisis; group 2 consisted of 36 eyes (20 patients) with macular bending; and group 3 consisted of 135 eyes (68 patients) without macular bending, foveoschisis, or other diseases. Macular bending was defined as a smooth macular elevation observed upon OCT in patients with pathologic myopia. Age, sex, spherical equivalence, axial length (AXL), and OCT findings were obtained and compared to identify factors that are related to myopic foveoschisis and macular bending. Moreover, using the whole data set, we evaluated and correlated myopic foveoschisis with the presence or absence of macular bending to determine whether this bulge in the macular area influences the development of myopic foveoschisis., Results: In group 1, all eyes presented posterior staphyloma and two factors were independently associated with a higher risk of having myopic foveoschisis: internal limiting membrane detachment (p < 0.001) and retinal arteriolar traction (p < 0.001). In group 2, only retinal arteriolar traction (p < 0.009) was independently associated with macular bending. Furthermore, macular bending was significantly correlated as a protective factor against myopic foveoschisis (adjusted odds ratio, 0.116; 95% confidence interval, 0.019 to 0.701; p < 0.019); the AXL of patients with the same spherical equivalence and macular bending was significantly shorter than that of patients without macular bending (p = 0.005)., Conclusions: Intraocular and extraocular wall factors were associated with myopic traction maculopathy, which plays an important role in its pathogenesis. Moreover, macular bending might be a key factor in preventing myopic foveoschisis by decreasing AXL.

Purpose: To review postoperative anatomical and functional outcomes in high myopic macular hole (HM-MH) without retinal detachment., Methods: In the PubMed database, published articles on myopic macular hole surgery from 2000 to 2013 (present days) were reviewed. Inclusion criteria were high myopia and macular hole (MH). Series with posterior retinal detachment secondary to MH and myopic foveoschisis (MFS) without MH were excluded. Main outcomes included MH closure rate, resolution of the foveoschisis, if present, and postoperative visual acuity. Optical coherence tomography (OCT) features and postoperative evolution were also evaluated when reported., Results: A total of 131 articles were initially found. After having applied the exclusion criteria, 15 articles were reviewed. Four were focused on HM-MH with concomitant foveoschisis (Schisis Group), and ten included only HM-MH without FS case series (Flat Group). Only one comparative study between these two groups was found. Surgical techniques were observed to be similar for both groups in most series, including vitrectomy with or without internal limiting membrane (ILM) removal, and gas or silicone oil tamponade. However, in one retrospective study, macular buckling was applied together with pars plana vitrectomy in cases of HM-MH with foveoschisis. When available, preoperative and postoperative OCT provided a useful evaluation of the status of the macula. Different prognosis were observed in the two groups in cases of vitreous surgery: anatomical success rate and functional outcomes for HM-MH with foveoschisis were markedly poorer than that for cases of HM-MH without foveoschisis, and multiple procedures might be required. By the contrast, better results seemed to be achieved using the posterior buckle technique for patients with HM-MH and concomitant foveoschisis. Moreover, when compared, final anatomical and functional outcomes seem to be less satisfactory than in emmetropic eyes. Postoperative non-closure or reopening of the macular hole is more common in eyes with HM-MH and concomitant foveoschisis, and possible retinal detachment may occur in these patients., Conclusions: Despite similar surgical procedures, anatomical and functional results after vitreous surgery in cases of HM-MH may be very different from series to series. The prognosis is generally better in cases involving only HM-MH without foveoschisis than in cases with MH and associated foveoschisis. Persistent MHs are more frequent in eyes with concomitant retinoschisis, and this seems to represent a possible risk factor for late retinal detachment in the case of unsuccessful vitreous surgery. However, although vitrectomy can lead to anatomical and visual improvements, an higher axial length > 30 mm and the presence of a posterior staphyloma seem to remain the two most important risk factors for poor visual outcomes. For these reasons, a different surgical approach, including macular buckling, might be considered in casse of HM-MH and concomitant myopic foveoschisis, in order to counteract the traction exerted by the posterior staphyloma.

Purpose: To investigate the factors linked to foveoschisis in high myopia., Methods: Retrospective study of 113 patients (200 eyes) with high myopia was conducted between January 2010 and June 2012. Subjects underwent a complete ophthalmic examination, spectral domain optical coherence tomography (OCT TOPCON 2000) and ocular echography., Results: Of the 200 eyes, 22 (11%) had foveoschisis on OCT examination. On the basis of univariate analysis, five variables were associated with the pathologic changes, including spherical equivalent over 10 diopters (P=0.044), axial length over 30 mm (P=0.0028), macular chorioretinal atrophy (P=0.0009), posterior staphyloma (P=0.0007) and vitreoretinal interface factors (P=0.0002). In the multivariate analysis, three factors were independently associated with foveoschisis in high myopia: axial length (adjusted OR, 16.7; IC 95% 1.4-219.7, P=0.036), macular chorioretinal atrophy (adjusted OR, 13.2; IC 95%, 1.3-133.1, P=0.044), and vitreoretinal interface factors (adjusted OR, 36.1; IC 95%, 3.5-376.9, P=0.002)., Conclusions: In our study, axial length, macular chorioretinal atrophy, and vitreoretinal interface factors were independently associated foveoschisis in highly myopic eyes., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate the efficacy of supra choroidal buckling procedure using a supra choroidal catheter, as a new approach in treating myopic vitreomacular interface disorders specially in difficult cases of myopic traction maculopathy with or without macular hole retinal detachment in posterior staphyloma depending on the concept of indenting the choroid only, from a 1-year data study., Methods: A newly developed supra choroidal catheter was used to deliver stabilized, cross-linked, long-acting hyaluronic acid as a filler in the supra choroidal space in the area of the staphyloma forming a choroidal indenting effect. Before the injection, pars plana vitrectomy was performed without internal limiting membrane peeling to avoid the risk of break of the roof of foveal detachment in case of foveoschisis. This indentation was used to treat 11 patients with myopic foveoschisis and 12 patients with myopic macular hole retinal detachment, 5 of whom had failed primary repair by vitrectomy before inclusion in this trial. Clinical and optical coherence tomographic evaluations of these patients were performed over 1-year follow-up., Results: Retinal layer restoration was achieved in all 11 eyes with myopic foveoschisis. This was gradual over a period of 2 to 6 weeks postoperatively. No recurrence over the 12-month follow-up was observed. Visual acuity improved by 1 line or more in 9 eyes (81.8%). Of the 12 eyes, 10 with macular hole detachment (83%) showed closure of the holes in association with the resolution of the detachment; 2 eyes showed resolution of the detachment and flatting of the edge of the holes but with incomplete closure on optical coherence tomography. Eight eyes (66.6%) showed improvement in visual acuity by 1 or more lines with no recurrence of retinal detachment over the 12-month follow-up period. The indentation effect was sufficient over the 12-month follow-up period., Conclusion: The indentation effect achieved by supra choroidal approach can be used as a method of managing myopic foveoschisis and myopic macular hole with detachment even in eyes with failed primary vitrectomy, counteracting the role of posterior staphyloma in the role of the disease. The indentation effect is sufficient for first year of follow-up.

Purpose: To evaluate the results of surgical treatment of maculopathy secondary to congenital optic pit anomaly with pars plana vitrectomy (PPV), endolaser to the temporal edge of the optic disc and C3F8 tamponade without internal limiting membrane (ILM) peeling., Patients and Methods: Thirteen eyes of 12 patients with serous macular detachment and/or macular retinoschisis secondary to congenital optic disc pit (ODP) were included in the study. All eyes underwent PPV, posterior hyaloid removal, endolaser photocoagulation on the temporal margin of the optic disc and 12% C3F8 gas tamponade. Anatomic success and functional outcome determined retrospectively by optical coherence tomography and measurement of best corrected visual acuity (BCVA), respectively were the main outcome parameters., Results: Two lines or more improvement in BCVA was obtained in 11 eyes and 6 of these eyes had 20/40 or better BCVA at the final visit. Subretinal or intraretinal fluid was completely resorbed postoperatively in 12 eyes but a little intraretinal fluid persisted in one eye at the 16-month follow-up. Better visual improvement was observed in patients treated by earlier surgical intervention., Conclusion: PPV, C3F8 gas tamponade and endolaser to the optic disc margin without ILM peeling may yield favourable results in the treatment of ODP maculopathy.

Purpose: To evaluate the effects of gas tamponade without vitrectomy in patients with myopic foveoschisis and foveal detachment., Methods: We examined 10 eyes of 10 patients with myopic foveoschisis and foveal detachment. All patients received an intravitreal injection of 0.2-0.4 mL C3F8 and remained in the prone position for 5 to 7 days. The patients were followed up for at least 6 months after the procedure. The refractive status, best-corrected visual acuity (BCVA), fundus changes, premacular disorders, and anatomical results before and after the treatment were assessed and recorded. All participants underwent serial optical coherence tomography (OCT)., Results: All patients had myopia of more than -7 diopters in the lesion eye. Staphyloma with chorioretinal atrophy was noted in all 10 eyes. The best-corrected visual acuity (BCVA) ranged from logMAR 0.52-2.0 before treatment. After initial gas tamponade, foveal detachment had resolved completely in four eyes and partially in four eyes at the 1-month follow-up visit, and two of the partially resolved cases achieved anatomical success after repeated treatment. Another eye achieved reattachment 15 months later and the other had a persistent but decreased level of detachment. Vitrectomy was subsequently performed in the one eye that showed increased detachment, and complete resolution of the schisis-detachment was achieved. The final BCVA improved in seven eyes and none of the study subjects showed decreased visual acuity., Conclusion: Gas tamponade is an alternative treatment for myopic foveoschisis with foveal detachment. More than 50 % cases showed a positive response with increased visual acuity. Further, the procedure did not appear to interfere with subsequent vitrectomy, if this procedure must be performed.

Background: The pathogenesis of optic nerve head pits and associated retinal detachment, and the most effective surgical intervention when visual loss develops, remains unclear., Methods: The morphology of the optic disk in patients with pits was investigated with optical coherence tomography. For those who underwent surgical treatment for pit-associated retinal detachment, the efficacy of treatment by vitrectomy and separation of the posterior hyaloid, with and without additional peeling of peripapillary tissue, was assessed., Results: On optical coherence tomography imaging, 14 of 18 pits (78%) demonstrated a localized pit-like invagination, whereas 3 (17%) had disks with a generally excavated structure. For 16 of 18 pits (89%), there was evidence of condensed vitreous or glial tissue seen extending from the pit or inside the optic disk. Nine eyes with retinal detachment underwent vitrectomy, posterior hyaloid separation, and endolaser. The retinal detachment completely resolved in 6 of 6 cases where the surgeon additionally peeled the fibrous tissue from the pit and 2 of 3 cases where this was not performed., Conclusion: Spectral domain optical coherence tomography demonstrates the varying morphology of optic pit anatomy. Condensed vitreous strands or glial tissue in the optic nerve pit may also contribute to retinal detachment development.

Vitreoretinal interface alterations leading to vitreopapillary and vitreomacular traction in a 29-year case of proliferative Eales' disease is described for the first time. On fundus examination, an ellipsoid area of vitreomacular traction was noted temporal to the optic disc. A triangular-shaped infolding of the retina was observed superior to the fovea. Epiretinal membrane was seen temporal to the disc involving the macula. Imaging by spectral domain optical coherence tomography in the papillomacular bundle region revealed retinoschisis at the level of the outer nuclear layer and confirmed the presence of retinal infolding and epiretinal membrane in the macular area. Three-dimensional imaging documented vitreoretinal interface alterations exquisitely.

Purpose: To determine the effectiveness of macular buckling in eyes with myopic foveoschisis and describe two methods of macular buckling: hard silicone implant and Ando plombe., Methods: Sixteen eyes of 16 consecutive patients with myopic foveoschisis who underwent surgery with the macular buckling procedure were studied. Pars plana vitrectomy combined with macular buckling with hard silicone implant was used in 6 eyes, whereas the other 10 eyes underwent pars plana vitrectomy and macular buckling with the Ando macular plombe., Results: Macular buckling, with both hard silicone implant and macular plombe resulted in reduction of retinal thickness in all patients. Best-corrected visual acuity improved in 14 of 16 eyes (87.5%), whereas it remained stable or decreased in 2 eyes (12.5%). Mean preoperative best-corrected visual acuity was 20/125 (mean logarithm of the minimal angle of resolution 0.8), whereas mean postoperative best-corrected visual acuity improved to 20/50 (mean logarithm of the minimal angle of resolution 0.39). Both methods showed a similar rate of complications, the most frequent being the development of localized areas of retinal pigment epithelium atrophy., Conclusion: Combined pars plana vitrectomy and macular buckling is an effective approach to treat myopic foveoschisis with both anatomical and visual improvement. Despite a similar complication rate with both buckling techniques, macular buckling with the Ando plombe was found to be technically easier with shorter surgical times.

Purpose: To study the features of posterior retinoschisis in high myopia before and after vitrectomy and its correlation with the visual outcome by spectral-domain optical coherence tomography (SD-OCT)., Methods: In this retrospective case series, 11 highly myopic eyes which underwent vitrectomy with internal limiting membrane peeling and gas tamponade for retinoschisis during June 2008 to December 2009 were followed up for 6 months. Visual acuity and SD-OCT (Topcon 3D OCT-1000) examination were performed before surgery and 1, 3, and 6 months after surgery., Results: Retinoschisis within the outer, middle, and inner layers was noted in six eyes, and foveal detachment was found in six eyes by SD-OCT preoperatively. The inner and outer segment junctions of the photoreceptor layer showed defects in all eyes. At 6 months postoperatively, the retina had reattached and schisis resolved in 10 eyes. Two parafoveal holes were noted in one eye after surgery. The best-corrected visual acuity increased from 0.15 to 0.8 in one eye, slightly improved in two eyes, and remained unchanged in eight eyes. The continuity of inner segment-outer segment layer almost completely recovered in the eye with best-corrected visual acuity of 0.8 while still showing defects in the other 10 eyes., Conclusions: SD-OCT can clearly demonstrate the morphological changes of retinoschisis. It provides important evidence as to the advantage of vitrectomy with internal limiting membrane peeling and helps to explain the visual outcome by documenting the recovery of the inner segment-outer segment layer after surgery. An SD-OCT examination should be considered in patients with high myopia and decreasing vision, with no obvious fundoscopic findings.

We report the diagnosis and treatment of patients with retinal detachment and/or retinoschisis associated with optic nerve coloboma or morning glory syndrome. A retrospective review of patients with optic nerve coloboma or morning glory syndrome with associated retinal detachment or retinoschisis was conducted. For five patients (six eyes), we report the clinical findings, spectral domain optical coherence tomography (OCT) imaging, intraoperative findings, and treatment outcomes. OCT scans demonstrate a bilaminar structure of maculopathy, consisting of inner schisis-like changes and outer layer retinal detachment. In most cases, a retinal break was demonstrated within the optic disc defect with three-dimensional OCT imaging. Glial tissue was sometimes observed within the anomalous defect. Vitrectomy and resection of the tractional tissue in these cases produced good anatomical and visual outcomes. Retinal detachment spontaneously resolved in cases where traction was not present. Traction may contribute to the pathogenesis of retinal detachment associated with colobomatous optic disc anomalies, either directly or by creating a secondary retinal break. OCT imaging assists with understanding the contributing factors to retinal detachment in individual cases of colobomatous optic disc anomalies and can thereby assist with determining the most effective approach to management.

Background: Pathological myopia is a frequent cause of secondary visual disturbance in young individuals worldwide. Myopic maculopathy describes a spectrum of clinical changes that comprise the main cause of visual loss among highly myopic individuals. Our aim is to describe current trends in the medical and surgical management of maculopathy secondary to pathological myopia., Methods: The epidemiology, natural history, medical and surgical treatment modalities for choroidal neovascular membrane (CNV) and vitreomacular disorders secondary to pathological myopia (PM) are reviewed and evaluated., Results: The medical and surgical treatment modalities in the management of myopic maculopathy have evolved over time. Laser photocoagulation, photodynamic therapy with verteporfin and other medical treatments have been superseded by the use of anti-vascular endothelial growth factor in the management of CNV secondary to PM. Surgical treatments are beneficial in the treatment of vitreomacular interface disorders such as macular hole retinal detachment and macular traction; however, primary success rates remain lower than those for non-myopic individuals., Conclusions: This updated clinical perspective demonstrates that CNV and vitreomacular disorders in pathological myopia are treatable conditions. There are numerous medical and surgical interventions that have significantly improved the outcome of myopic maculopathy and several others currently under investigation. Nonetheless, as technology advances, further well-designed studies are necessary to establish a uniform evidence-based approach for classification and treatment.

Background: To describe a case of macular retinoschisis in a patient with normal tension glaucoma without evidence of optic nerve pits or peripapillary retinoschisis., Methods: Case report., Results: This patient, diagnosed with normal tension glaucoma, was noted to have macular retinoschisis in the right eye, with matching changes on visual field and optical coherence tomographic (OCT) results. Follow-up examination revealed that the schisis kept on appearing in the right eye., Conclusions: Macular retinoschisis may appear in patients with normal tension glaucoma. It is possible that microholes in the thinning and structural defects areas in the nerve fiber layer around the optic cup allowed liquid vitreous to enter the retina via the nerve fiber layer. The fluid caused retinal edema, a schisis and even a serous retinal detachment. Further studies are needed to better understand this disease process.

Purpose: To determine the incidence and features of macular retinal detachment (RD) after successful intravitreal injection of bevacizumab (IVB) for the treatment of myopic choroidal neovascularizations (CNVs)., Methods: Seventy-four eyes of 74 patients who received IVB for myopic CNV were studied. Fluorescein angiography (FA) and optical coherence tomography (OCT) were performed at baseline, at 1 week after IVB, and every month thereafter. The shortest follow-up period was 6 months., Results: Four eyes (5.4%) either developed or had increased macular RD after successful IVB. In the three eyes, macular RD newly developed 1 month after IVB despite the absence of dye leakage. The remaining eye had a limited area of macular RD at baseline and increased despite the disappearance of dye leakage from the CNV after the IVB. The four eyes that developed a macular RD had retinoschisis around the CNV before IVB, whereas none of the 70 other patients had a retinoschisis throughout the follow-up period. In all four eyes that either developed or had increased macular RD, outer lamellar holes were detected at the upper edge of the RD by OCT examinations, whereas none of the patients who did not develop a macular RD after IVB showed outer lamellar holes., Conclusions: These results suggest that there is a risk of developing macular RD after IVB in eyes with myopic CNV. Periodic OCT examinations are recommended for patients with myopic CNV to search for RDs after IVB.

Objective: To evaluate the efficacy of vitrectomy without internal limiting membrane (ILM) peeling associated with gas tamponade in eyes with myopic foveoschisis., Methods: A prospective study was conducted, in which 49 pathological myopia patients (52 eyes) with myopic foveoschisis were enrolled and divided into three groups according to the different therapeutic procedures: 22 patients (24 eyes) underwent vitrectomy without internal limiting membrane (non-gas tamponade group), 15 patients (16 eyes) received vitrectomy without internal limiting membrane peeling but combined with gas tamponade (gas tamponade group) and 12 patients (12 eyes) did not receive surgical treatments (control group). SAS 9.13 was used for the statistic analysis. Best-corrected visual acuity (BCVA) and optical coherence tomographic (OCT) findings of the foveal thickness before and after the operation (the 3rd, 6th, and 9th month postoperatively) were obtained and compared by the Wilcoxon Rank-Sum test. Non-parameters Wilcoxon symbols test was used to compare the BCVA, the central foveal thickness (CFT) and maximum foveal thickness (MxFT) of each group before and after the surgery., Results: Postoperative visual acuity was significantly increased in the two operation groups (t = 2.57, P < 0.05; t = 3.58, P < 0.05) but not increased in the control group (t = 1.84; P > 0.05). The difference of BCVA between these three groups was not significant (χ(2) = 0.24, P > 0.05). OCT showed the mean foveal thickness was significantly decreased postoperatively. Vitrectomy without peeling of the ILM significantly promoted the retinal reattachment in eyes with myopic foveoschisis. No retinal reattachment was found in the control group while 16 and 13 retinal reattachment were found in the non-gas tamponade (66.7%) and gas tamponade group (81.3%), the difference between these two operation groups and the control was statistically significant (χ(2) = 20.50, P < 0.05). During the follow-up, two eyes in the control group developed a macular hole and both developed retinal detachment (RD) in the 6 and 8 month, respectively. The remaining 10 eyes did not develop any complications, although the thickness of the macula increased significantly. A transient increase of intraocular pressure occurred in three eyes and had been cured by medications within 2 weeks after gas tamponade. A macular hole was recognized in one eye 2 months after surgery and the retina was reattached at the fovea 1 month after reoperation., Conclusions: Vitrectomy without ILM peeling could be a safe and effective surgical approach for the treatment of foveoschisis in pathologic myopia. In addition, gas tamponade can improve the success rate of the operation.

Purpose: To determine the retinal features seen on enhanced spectral-domain optical coherence tomography (SD-OCT) associated with foveal retinal detachment in eyes with myopic macular retinoschisis., Design: Retrospective case series., Methods: We reviewed fundus photographs and conventional and enhanced SD-OCT images of 21 eyes of 19 patients with myopic macular retinoschisis. Features seen on enhanced SD-OCT images were identified and compared between eyes with and without foveal detachment., Results: On enhanced SD-OCT images, the retinoschisis in the outer retina was accompanied by splitting in the inner plexiform layer (IPL) in 11 eyes (50.0%) and a detachment of the inner limiting membrane (ILM) in 11 eyes (50.0%) in the superior and/or inferior peripheral macula; 9 eyes (42.9%) had both features. Multiple columnar structures were seen throughout the outer retinoschisis in 20 of 21 eyes (95.2%), and in ILM detachment/IPL retinoschisis in all eyes. Thirteen eyes had or progressed to a foveal detachment; an ILM detachment developed in 10 eyes (76.9%) with a foveal detachment and in 1 eye (12.5%) without a foveal detachment (P = .008). IPL retinoschisis was detected in 8 eyes (61.5%) with a foveal detachment and 3 eyes (37.5%) without a foveal detachment, but this difference was not significant., Conclusions: An ILM detachment in the superior and/or inferior peripheral macula was associated with a foveal retinal detachment in highly myopic eyes with macular retinoschisis. This feature may indicate strong tractional forces on the ILM that are transmitted to the outer retina through the dense columnar structures, resulting in a foveal retinal detachment., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Topic: To review systematically the diagnostic accuracy of various ocular signs for pediatric abusive head trauma (AHT)., Clinical Relevance: Intraocular hemorrhages (IOH), perimacular retinal folds, traumatic retinoschisis and optic nerve sheath hemorrhages have been reported as cardinal signs of AHT. The evidence base supporting the accuracy of this interpretation, however, has not been systematically reviewed., Methods: A systematic keyword search of MEDLINE, EMBASE, and Evidence-Based Medicine Reviews was conducted for original studies reporting ocular findings in AHT. Articles were graded using a checklist for systematic reviews of diagnostic accuracy., Results: The initial search yielded 971 articles, of which 55 relevant studies were graded, and 20 studies met inclusion criteria and were included in the review. The overall sensitivity of IOH for AHT was 75% and their specificity was 94%. Intraretinal hemorrhage at the posterior pole was the most common finding, although extensive, bilateral, and multilayered IOH were the most specific for AHT. Optic nerve sheath hemorrhages had a sensitivity and specificity for AHT of 72% and 71%, respectively. Traumatic retinoschisis and perimacular retinal folds were reported in 8% and 14% of AHT, respectively, but were not reported in other conditions., Conclusions: Prospective, consecutive studies confirm that IOH in infants-particularly bilateral, extensive, and multilayered-are highly specific for AHT. Optic nerve sheath hemorrhages are significantly more common in AHT than in other conditions, in autopsy studies. Traumatic retinoschisis and perimacular folds are present in a minority of AHT, but rarely seen in other conditions., (Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To report a new and atypical pathology of epiretinal membrane formation on the top of the retinoschisis (schisis-membrane)., Methods: We describe a patient with recent visual acuity and visual field deterioration due to a rapid progression of retinoschisis in the macular area resulting from shrinking membrane on the top of the schisis. The patient underwent vitrectomy with membrane removal., Results: Partial regression of the schisis was observed and visual acuity improved from 5/12 to 5/5. Perimetry demonstrated that the corresponding visual field deterioration partially regressed., Conclusions: Release of traction exerted by a shrinking membrane is a surgical option to promote regression of retinoschisis and improvement in visual field and vision in schisis-membrane cases.

Purpose: To report a case of symptomatic myopic retinoschisis with foveolar detachment and lamellar macular hole, treated with expansible gas., Methods: Interventional case report. A myopic patient presented with a history of decreased vision and metamorphopsia in his right eye. Optical coherence tomography (OCT) revealed an increased macular thickness, thinning and separation of the inner and external retina (retinoschisis or foveoschisis), foveolar detachment, lamellar hole, and foveolar vitreous traction. We treated the patient with a single dose of 0.2 mL of perfluoroethane (C2F6), performed under retrobulbar anesthesia, followed by prone posturing for 15 days., Results: OCT showed reattachment of the foveolar retina, disappearance of the retinoschisis, and visual acuity improvement., Conclusions: Intraocular expansible gas and prone posturing, without vitrectomy, could be an alternative treatment in selected cases of symptomatic macular foveoschisis with foveolar detachment, in the absence of dense epiretinal membranes.

Purpose: To describe features associated with the development and resolution of peripapillary retinoschisis with an underlying serous detachment in a patient with primary open angle glaucoma. This presentation occurred in the absence of an observed optic nerve coloboma, congenital, or acquired optic nerve head pit., Case Report: A patient with advanced glaucomatous optic nerve cupping developed a temporally localized peripapillary serous detachment in the right eye which spontaneously resolved., Results: Optical coherence tomography demonstrated an area of retinoschisis with underlying serous detachment contiguous with the temporal disc margin. Although fluorescein angiography was not performed and the presence of a peripapillary subretinal neovascular membrane could not be ruled out, an atypical coloboma, optic nerve head pit, or peripapillary subretinal neovascular membrane was not observed during biomicroscopy or scanning laser ophthalmoscopy. The retinoschisis and detachment resolved without intervention., Conclusion: Peripapillary retinoschisis with an underlying serous detachment may develop in subjects with advanced glaucoma. Although the occurrence of the findings in this case may be unrelated to glaucomatous optic neuropathy, the likelihood that a pathogenic mechanism linked to advanced glaucoma may be responsible for the development of peripapillary schisis and serous detachment should alternatively be taken into consideration. This case documents its spontaneous resolution without intervention.

This study shows how optical coherence tomography has been valuable in the diagnosis of congenital X-linked retinoschisis. An infant with convergent strabismus underwent serial optical coherence tomography examinations that helped to make the diagnosis of congenital X-linked retinoschisis. Optical coherence tomography is useful in the diagnosis of congenital X-linked retinoschisis and adds new information about pathogenesis. The authors recommend the use of optical coherence tomography in pediatric retinal disease, even if the macula appears normal on indirect ophthalmoscopy., (Copyright (c) 2010, SLACK Incorporated.)

Purpose: To describe inferior peripheral retinal elevations associated with intermediate uveitis., Methods: Retrospective review., Results: Eleven eyes of 7 patients developed inferior retinal elevation secondary to intermediate uveitis. Six eyes (54.6%) were believed to have tractional retinoschisis, 2 (18.2%) had tractional retinal detachment, and the remaining 3 (27.3%) had flat retinal elevation of indeterminate type. In 10 eyes there was no evidence of progression during a mean 4-year follow-up. One eye developed extended tractional elevation with macular pucker and failed to respond to surgery. At the most recent visit, visual acuity ranged from 6/5 to NPL with a median of 6/12., Conclusion: Intermediate uveitis may cause inferior peripheral retinal elevation. The authors propose that preretinal and pars plana gliosis resulting from chronic pars planitis exerts traction on peripheral retina, causing elevation, but infer that such elevation removes traction and is self-limiting. Surgery should be reserved only for macula threatening lesions.

The optic nerve head pit is a congenital anomaly of the optic disc due to imperfect closure of the superior edge of the embryonic fissure. We studied in detail by means of fluorescein angiography (FLA), microperimetry (fundus related perimetry), and ocular coherence tomography (OCT) the case of a 30-year-old woman who had an optic pit with secondary retinoschisis in her right eye.

The objective of this study was to evaluate the clinical curative effect of posterior scleral reinforcement for macular retinoschisis in highly myopic patients. Twenty-four highly myopic eyes with macular retinoschisis were treated with posterior scleral reinforcement surgery from September 2005 to March 2007 in our hospital. Visual field, best corrected vision acuity (BCVA), refractive error, optical coherence tomography and A/B Scan ultrasound graphy results were retrospectively analysed. The central visual field in 18 eyes was improved after surgery; optical coherence tomography showed complete resolution of the myopic foveoschisis in 20 (83.33%) of the 24 eyes after surgery. The postoperative BCVA was improved by 0.1 or more in 18 eyes (75%), and remained within 0.1 of the preoperative BCVA in five eyes (20.83%) at the end of follow-up. Compared with the preoperative data of 23 eyes, the final magnitude of myopia after surgery was significantly decreased (t = 3.527, P = 0.002). In conclusion, this procedure can effectively treat highly myopic patients with macular retinoschisis without macular hole or retinal detachment, and might be better for maintaining central vision and preventing the occurrence of complications.

A patient with progressive visual loss and macular hole development due to progressive myopic traction maculopathy was studied using spectral domain optical coherence tomography (SD-OCT). A characteristic, deep retinal schisis-like change was clearly demonstrable. Progression to a full-thickness macular hole was documented. Postoperatively, the macular hole was closed, and the visual acuity was restored. SD-OCT imaging allowed better resolution of macular features but requires evaluation of all scan data. The source of progressive inner retinal traction may be the posterior extension of the staphyloma.

Purpose: To report on the efficacy of the oral carbonic anhydrase inhibitor (CAI) acetazolamide in treating macular retinoschisis (RS) in the rare vitreoretinal dystrophy best known as the enhanced S-cone syndrome (ESCS)., Design: Interventional case report., Methods: setting: University-based practice. patient: A 48-year old Jewish Italian male with clinically, functionally, and molecularly confirmed ESCS, attributable to homozygosity for the R311Q mutation in the NR2E3 gene, presented with sudden visual acuity (VA) loss (20/200) and metamorphopsia in the left eye resulting from acute, late-onset, asymmetric macular RS. intervention: Open-label, off-label treatment with the oral CAI acetazolamide. main outcome measure(s): Best-corrected VA, retinal thickness, and retinal microanatomy, assessed by Stratus optical coherence tomography (OCT) criteria., Results: Following treatment, instituted one month after the acute-onset VA loss, retinal thickness and microanatomic profile normalized in the affected eye, with restoration of 20/20 corrected VA. The fellow eye, which had remained asymptomatic at 20/16 vision, had experienced mild paracentral macular RS evident by OCT criteria, which also resolved completely following oral CAI treatment. The outcome was maintained throughout the follow-up period at a low maintenance dose., Conclusions: Taken together with other recent reported benefits of topical and oral CAIs in the treatment of macular RS in X-linked retinoschisis, this interventional case report shows that CAIs can be used to treat effectively macular RS in general, and also specifically in ESCS.

Purpose: To investigate the associated factors of foveoschisis and foveal detachment without macular hole in highly myopic eyes., Methods: A cross-sectional study of 124 eyes of 68 highly myopic patients was performed. The patients underwent complete ocular examination, fundus photography, and optical coherence tomography (OCT)., Results: Of the 124 eyes, 10 (8%, 10/124) had foveoschisis or foveal detachment without a macular hole on OCT examination. On the basis of univariate analysis, six variables were associated with the pathologic changes, including age over 40 years (P=0.018), spherical equivalent over 10 D (P=0.042), axial length over 31 mm (P=0.001), macular chorioretinal atrophy (P=0.00003), posterior staphyloma (P=0.0003), and vitreoretinal interface factors, including epiretinal membrane, posterior vitreoschisis, and vitreomacular traction (P=0.00002). In the multivariate analysis, three factors were independently associated with foveoschisis and foveal detachment without macular hole in high myopia: axial length, macular chorioretinal atrophy, and vitreoretinal interface factors., Conclusions: Foveoschisis and foveal detachment without macular hole are sight-threatening disorders in highly myopic eyes. Axial length, macular chorioretinal atrophy, and vitreoretinal interface factors were independently associated with these pathological conditions. Thus, both intraocular and outer ocular wall factors play important roles and merit further study.

Purpose: To report three cases of nanophthalmos associated with acquired (senile) retinoschisis., Design: Observational case series., Methods: Complete ophthalmologic evaluation (including funduscopy with scleral indentation, total axial length measurement with A-scan, optical coherence tomography [Stratus 3 OCT; Carl Zeiss Meditec Inc, Dublin, California, USA], and fundus photography) of three consecutive patients presenting with nanophthalmos and acquired retinoschisis., Results: Three patients with nanophthalmos presented with bilateral acquired retinoschisis. One patient underwent a course of systemic steroids to treat concurrent and bilateral uveal effusion with macular edema. In this patient, one eye responded to this course of therapy without recurrence, while the fellow eye required vortex vein decompression with scleral windows, with subsequent, successful resolution. The average follow-up period was 40 months (range, eight to 95 months). Retinoschisis cavities remained stationary in each case., Conclusions: Bilateral acquired retinoschisis may occur in patients with nanophthalmos, suggesting that there may be correlation in the mechanisms underlying these ocular disorders.