An Association Between Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis, Peripheral Retinoschisis, and Posterior Hyaloid Attachment

Abstract

The precise pathophysiological mechanism of stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) is unknown. This study demonstrates an association between SNIFR and incomplete posterior hyaloid detachment, indicating a possible tractional etiology, as well as a relationship with peripheral retinoschisis and extramacular absolute scotoma, despite retention of good central visual function.

Stellate nonhereditary idiopathic foveomacular retinoschisis and an approach to the differential diagnosis of macular star

“…Interestingly, in the original SNIFR report, half of eyes also showed peripheral retinoschisis in inner retinal layers [1]. This finding has been replicated in more recent publications on widefield OCT suggesting an overlapping pathophysiology between foveal and peripheral retinoschisis [2 ▪▪ ,10–13]. As is typical of retinoschisis, fluorescein angiography usually shows absence of leakage in the macula (Fig.…”

“…On fundus examination, the foveal reflex may be blunted with apparent elevation and foveal cysts in a stellate configuration (Fig. 1) [1,2 ▪▪ ]. This pattern becomes more evident on en face infrared imaging [5].…”

“…SNIFR is a diagnosis of exclusion, made when classic imaging findings cannot be explained by other known causes of foveomacular retinoschisis and/or stellate maculopathy (discussed below). Reports to date have demonstrated a strong female predominance in SNIFR, though the reason for this has yet to be elucidated [1,2 ▪▪ ]. SNIFR has been described in individuals ranging from 26 to 85 years of age [1,2 ▪▪ ,3], though the average patient is usually in their 60 s. Patients are most often asymptomatic on presentation but may report decreased vision or metamorphopsia [1,2 ▪▪ ,3–6].…”

“…Reports to date have demonstrated a strong female predominance in SNIFR, though the reason for this has yet to be elucidated [1,2 ▪▪ ]. SNIFR has been described in individuals ranging from 26 to 85 years of age [1,2 ▪▪ ,3], though the average patient is usually in their 60 s. Patients are most often asymptomatic on presentation but may report decreased vision or metamorphopsia [1,2 ▪▪ ,3–6]. In general, central visual acuity is well preserved.…”

“…In general, central visual acuity is well preserved. In the absence of other structural change, average visual acuity ranges from 20/20 to 20/30 [1,2 ▪▪ ]. In the rare cases of vision worse than 20/50, other factors such as subretinal fluid or exudative maculopathy are usually seen [1,7].…”