Myopic macular retinoschisis with microvascular anomalies

Durkin, Shane R.; Polkinghorne, Philip J

doi:10.1038/eye.2013.284

Cited by 11 publications

(10 citation statements)

References 9 publications

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“…Myopic foveoschisis and retinal detachment in patients with high myopia are not rare. 5 Takano and Kishi 6 described the presence of retinoschisis and foveal detachment in 11 of 32 eyes (34%) in patients with high myopia and posterior staphyloma. Stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) is defined as a foveal elevation without alternative explanation for retinoschisis.…”

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confidence: 99%

Stellate Unilateral Nonhereditary Idiopathic Foveomacular Retinoschisis: A Multimodal Imaging Analysis and Case Report

Montano¹,

Alfaro²,

Lima-Gómez³

et al. 2020

RETINAL Cases &Amp; Brief Reports

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Purpose: To describe a case of stellate nonhereditary idiopathic foveomacular retinoschisis in a middle-aged woman and to depict the classic retinal fluorangiography (FA) findings, structural characteristics using macular spectral-domain optical coherence tomography angiographic data of vascular and perfusion density using optical coherence tomography angiography (OCT-A), and standardized multifocal electroretinography (mfERG) findings.Methods: This is a case report of a 53-year-old ophthalmologist who was incidentally diagnosed with unilateral idiopathic foveomacular retinoschisis. Stellate nonhereditary idiopathic foveomacular retinoschisis is defined as a foveal elevation without alternative explanation for retinoschisis. FA, spectral-domain optical coherence tomography, optical coherence tomography angiography, and multifocal electroretinography were used as tools to obtain an integral multimodal diagnosis of this entity.Results: Clinical examination and multimodal imaging were able to detect unilateral idiopathic retinoschisis, revealing a stellate pattern of retinal concentric cysts with minimal changes in vascular and perfusion density metrics and confirming the absence of bridging vessels. There were consistent FA findings, with almost unaltered foveal changes. Multifocal electroretinography depicted a subtle reduction in dark-adapted a-wave and b-wave amplitudes.Conclusion: Improvements and innovations in technology for ophthalmic diagnosis have revolutionized our capacity for diagnostic decision-making. Spectral-domain optical coherence tomography and optical coherence tomography angiography are useful tools for diagnosis and follow-up assessment. This fortuitous case gives a window on the importance of a routine specialized ophthalmic examination and how multimodal imaging can depict important and specific findings not evident from a clinical point of view. The subtle but important changes observed in optical coherence tomography angiography and multifocal electroretinography will help better define this clinical entity.

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confidence: 99%

Stellate Unilateral Nonhereditary Idiopathic Foveomacular Retinoschisis: A Multimodal Imaging Analysis and Case Report

Montano¹,

Alfaro²,

Lima-Gómez³

et al. 2020

RETINAL Cases &Amp; Brief Reports

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“…Others reported cases of microvascular abnormalities with similar appearance to neovascularization, which were considered as compensation for the schitic process instead. Durkin et al [3] reported a case of retinal microvascular abnormalities appearing to be "dilated capillary terminals" without fluorescein leakage secondary to myopic retinoschisis, and hypothesized that capillary remodeling occurred as the inner and outer retinal leafs separated, which may induce bleeding if the schitic cavity progressed more rapidly, mimicking leakage of neovascularization in FFA. Ong et al [6] reported retinoschisis-related telangiectatic retinal vessels or retinal aneurysmal dilatations in the absence of capillary non-perfusion in OCTA, disputing ischemia-induced neovascularization.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, we would like to stress the role of superficial retinoschisis in the initiation of neovascularization process. OCT images of similar cases were reviewed in myopic and primary retinoschisis in patients, and we found that the schisis mostly involved RNFL and/or GCL, with deeper layers involved in some cases [2,3,6] We hypothesized that ischemia is more prominent in superficial retinoschisis, as loss of blood supply due to tear of superficial capillary plexus (SCP) could render the inner retinal layer almost completely ischemic, which triggers a molecular cascade and subsequent retinal neovascularization elicited by vascular endothelium growth factor (VEGF). Unfortunately, since the lesion was not at a routine location for our OCTA scan and the quality of FFA from her local hospital was not high enough to visualize non-perfusion area, we couldn't rule out either retinoschisis-related vascular remodeling or ischemia-induced neovascularization.…”

Section: Discussionmentioning

confidence: 99%

“…Peripheral Retinal neovascularization is well-described as a complication of X-linked retinoschisis [1], but less often observed in myopic and primary retinoschisis. There are some cases reported as retinal neovascularization [2] or microvascular abnormalities [3], yet their nature remains debatable. In this report, we present a case of retinal microvascular abnormalities, possibly neovascularization and subsequent vitreous hemorrhage secondary to highly myopic superficial retinoschisis.…”

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Peripheral retinal neovascularization secondary to highly myopic superficial Retinoschisis: a case report

Luo

Hua

et al. 2020

BMC Ophthalmol

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Background: Peripheral Retinal neovascularization is well-described as a complication of X-linked retinoschisis, but less often observed in myopic and primary retinoschisis. We present a case of a myopic female who developed retinal microvascular abnormalities due to retinoschisis and subsequent vitreous hemorrhage which would cause severe visual damage without timely and proper treatment. Case presentation: A 38-year-old highly myopic Chinese female complained of blurred vision in her right eye. Her best corrected visual acuitiy was 20/20 OU, and her refraction was − 9.00S OU. Dilated fundus examination revealed mild vitreous hemorrhage and abnormal vascular network nasal to the optic disc in her right eye. Optical Coherence Tomography (OCT)-angiography (OCTA) B-Scan showed superficial retinoschisis and well-depicted abnormal retinal microvascular network in inner retinal layer. Sectoral scatter laser photocoagulation was administered. Regression of most abnormal vessels was achieved in 1 month, but the patient experienced an unexpected episode of vitreous hemorrhage 3 months after the initial treatment, which was absorbed spontaneously in 2 weeks. Supplemental laser photocoagulation was applied and regular follow-up visit was suggested. Conclusion: Superficial retinoschisis in pathological myopia can be a driver of retinal microvascular abnormalities, possibly neovascularization, an extremely rare but severe complication which can be vision-threatening without timely and proper intervention.

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“…For instance, myopic macular retinoschisis has been associated with the disruption of retinal microcirculation. 6 Juvenile X-linked retinoschisis has been linked to avascularity in areas of schisis and peripheral retina, underdeveloped capillaries, and peripheral neovascularization. 7 Moreover, chronic retinal detachment with macrocyst formation has been linked to peripheral capillary nonperfusion, telangiectasias, and retinal neovascularization.…”

Section: Discussionmentioning

confidence: 99%

Neovascularization of the iris in retinoschisis

Slean

Chen

et al. 2017

American Journal of Ophthalmology Case Reports

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PurposeTo report the association of rubeosis iridis with chronic bullous degenerative peripheral retinoschisis.ObservationsA 63-year-old female presented with acute hyphema and neovascularization of the iris in association with elevated intraocular pressure. Posterior segment examination including imaging revealed no vascular occlusion as a potential cause. However, large, peripheral bullous retinoschisis was noted in the right eye. No nonperfusion aside from that seen within the schism detachment, or neovascularization of the retina on wide-field fundus photography or fluorescein angiography was noted. Bullous retinoschisis was also found in the left eye. The patient was treated conservatively with prednisolone acetate and timolol eye drops.Conclusions and importanceChronic bullous retinoschisis can be associated with anterior segment neovascularization such as rubeosis iridis, presumably due to non-perfusion within the retinoschisis cavity.

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Myopic macular retinoschisis with microvascular anomalies

Cited by 11 publications

References 9 publications

Stellate Unilateral Nonhereditary Idiopathic Foveomacular Retinoschisis: A Multimodal Imaging Analysis and Case Report

Stellate Unilateral Nonhereditary Idiopathic Foveomacular Retinoschisis: A Multimodal Imaging Analysis and Case Report

Peripheral retinal neovascularization secondary to highly myopic superficial Retinoschisis: a case report

Neovascularization of the iris in retinoschisis

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