Case Report: Glaucoma-associated Peripapillary Retinoschisis with Corresponding Lamina Cribrosa Defect

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.

Disc hemorrhage following peripapillary retinoschisis in glaucoma: a case report

“…Even an association between retinoschisis and DH may be mere coincidence. Second, mechanical changes in the optic discs, such as LC defects, may share a common pathophysiology with these two phenomena [ 5 , 9 ] However, no distinct anatomical change of the optic nerve has been found even with the currently available multimodal imaging. Hence, this could be a possible hypothesis.…”

“…In contrast, some studies have reported peripapillary retinoschisis in glaucoma, but it is not recognized as a pathognomonic finding, and opinions on the exact cause or clinical significance of retinoschisis are not consistent. Glaucoma-associated peripapillary retinoschisis often stabilises or spontaneously resolves [3][4][5]; however, some studies have reported that peripapillary retinoschisis is associated with rapid glaucoma progression [6,7]. There have been no reports of these two findings in the same eye and a relationship between DH and peripapillary retinoschisis.…”

Optical coherence tomographic findings of glaucomatous eyes with papillomacular retinoschisis

“…[1][2][3][4] Several single case reports or case series have reported that papillomacular retinoschisis (PMRS) is present in eyes with a glaucomatous optic disc. [5][6][7][8][9][10][11][12][13][14][15][16][17] The pathogenesis for the PRMS associated with glaucoma has not been de nitively determined. Based on the ndings of fundus uorescein angiography (FA) and optic coherence tomography (OCT), vitreous uid or cerebrospinal uid (CSF) appears to be the source of the uid in the PMRS although this has also not been de nitively determined.…”

Optical coherence tomographic findings of glaucomatous eyes with papillomacular retinoschisis

“…[1][2][3][4] Several single case reports or case series have reported that papillomacular retinoschisis (PMRS) is present in eyes with a glaucomatous optic disc. [5][6][7][8][9][10][11][12][13][14][15][16][17] The pathogenesis for the PRMS associated with glaucoma has not been de nitively determined. Based on the ndings of fundus uorescein angiography (FA) and optic coherence tomography (OCT), vitreous uid or cerebrospinal uid (CSF) appears to be the source of the uid in the PMRS although this has also not been de nitively determined.…”

“…20 Some studies have shown that the relationship between a LC defect and PMRS in glaucomatous eyes was based on the OCT ndings. 17 The slope of the ONH margin can be classi ed as an externally oblique margin or an internally oblique margin, 21 and Jong et al showed that the length of the externally oblique slope was associated with the existences of LC defects in myopic glaucomatous eyes. 22 Other researchers have focused on the obliquity of the ONH margin in glaucomatous eyes, 23,24 but the relationship between the slope of the ONH margin and PMRS including the association with the LC defects has not been determined.…”