Membrane tissue on the optic disc may cause macular schisis associated with a glaucomatous optic disc without optic disc pits

Abstract

This article reports a case of possible involvement of membrane tissue on the optic disc with macular schisis formation associated with glaucomatous optic disc without optic disc pits. A 78-year-old man presented with loss of central visual acuity of the left eye. He had a medical history of primary open-angle glaucoma. Visual acuity was 0.6 in his left eye, and funduscopy revealed macular schisis and a glaucomatous optic disc without optic disc pits. Optical coherence tomography (OCT) revealed membrane tissue on the optic disc and a tunnel-like hyporeflective lesion connecting the schisis cavity and a site near the tissue, but no obvious optic disc pit. He underwent pars plana vitrectomy during which the membrane tissue on the disc and internal limiting membrane were removed. Posterior vitreous detachment was observed intraoperatively. Thereafter, the tunnel-like lesion observed on OCT was rapidly obscured and the macular schisis gradually reduced. Eighteen months after surgery, his visual acuity had improved to 0.9 with almost complete regression of the macular schisis. No optic disc pit was visualized after surgery. The changes in OCT findings described here suggest an etiology for macular schisis without optic disc pits in an eye with a glaucomatous optic disc with posterior vitreous detachment. A connection between the schisis cavity and the vitreous cavity may have appeared via the tunnel-like structure due to the membrane tissue exerting traction on the optic disc.

Clinical Characteristics of Idiopathic Foveomacular Retinoschisis

“…21 Conversely, some studies have reported that vitrectomy effectively reduced the retinoschisis even in cases with glaucoma, which may not be associated with any tractions. 26,27 The morphologic effectiveness of vitrectomy with ILM peeling also has been reported in eyes with X-linked retinoschisis, 4 which is not associated with the effect of the vitreous but a hereditary retinal layering abnormality. These may indicate that vitrectomy with ILM peeling accelerates the diffusion of serous fluid from the retina to the vitreous.…”

“…[19][20][21][22] Those diseases have definite causes such as congenital retinal abnormalities and vitreous traction. Foveoschisis also has been reported in eyes with glaucoma, [23][24][25][26][27] which indicates the vulnerability of the optic disk in glaucomatous eyes. In the current study, we report our experience in elderly patients with idiopathic foveomacular retinoschisis, which is not inherited and not associated with myopia, VMTS, pit macular syndrome, or glaucoma.…”

Peripapillary retinal splitting visualized on OCT in glaucoma and glaucoma suspect patients

“…[ 8 ] There has also been suggestion of a communicating bridge connecting the optic disc and the macular retinoschisis region, contraction of the membrane tissue on the optic disc creating a cleft, an optic nerve anomalous excavation functioning similar to a bulb syringe, and entry of vitreous through the lamina cribrosa, which may also be influenced by alterations in pulse or in the intracranial pressure due to changes in posture. [ 2 ] [ 17 ] [ 18 ] [ 19 ] [ 20 ] None of the eyes in our series had evidence of optic pits on OCT which have been associated with schisis. [ 2 ] [ 21 ] [ 22 ]…”

Role of the Epipapillary Membrane in Maculopathy Associated with Cavitary Optic Disc Anomalies: Morphology, Surgical Outcomes, and Histopathology

“…Retinal schisis disappeared or improved after PPV with the generation of PVD in patients with retinoschisis associated with glaucoma without preoperative PVD [ 22 ]. Furthermore, retinal schisis was resolved following PPV with the removal of the glial tissue present on the disc in a patient with preoperative PVD [ 21 ]. These studies suggest that the posterior hyaloid membrane and/or glial tissue on the disc is related to the pathogenesis of retinoschisis associated with glaucoma.…”