Rhegmatogenous Retinal Detachment Due to Paravascular Linear Retinal Breaks Over Patchy Chorioretinal Atrophy in Pathologic Myopia

Abstract

To characterize posterior paravascular linear retinal breaks over areas of patchy chorioretinal atrophy as a cause of retinal detachment among patients with pathologic myopia.Methods: In this retrospective case series, we evaluated 10 pathologically myopic eyes having rhegmatogenous retinal detachment associated with posterior paravascular linear retinal breaks.Results: Ten eyes with posterior paravascular linear retinal breaks and retinal detachment were identified from January 1, 2008, to July 31, 2009. The retinal breaks were most frequently found along the inferotemporal vascular arcade, followed by the superotemporal arcade. The length of the breaks ranged from 0.25 to 1 disc diameter, and their distance from the optic disc ranged from 1 to 5 disc diameters. These paravascular linear retinal breaks have distinct clinical characteristics, including a strong propensity to occur over areas of patchy chorioretinal atrophy, a linear shape that is oriented parallel to the adjacent retinal vessels, and a tendency to result in progressive retinal detachment. Vitrectomy with gas tamponade was performed in all cases, and retinal reattachment was achieved in 9 cases by a single operation.Conclusions: Paravascular linear retinal breaks over areas of patchy chorioretinal atrophy represent a distinct clinical entity that can result in a special category of retinal detachment among patients with pathologic myopia. These breaks are apt to elude detection before surgery, and a careful search along the posterior vascular arcades during vitrectomy may help to detect these abnormalities. Pars plana vitrectomy with photocoagulation and intraocular tamponade may lead to a resolution of such rhegmatogenous retinal detachments.

Vitrectomy With or Without Internal Limiting Membrane Peeling for Each Stage of Myopic Traction Maculopathy

“…The presence of a paravascular lamellar retinal hole has been reported to be frequent in eyes with high myopia with premacular fibrosis and paravascular full-thickness retinal breaks. 29,30 These lamellar or full-thickness paravascular retinal breaks in highly myopic eyes may cause cellular proliferation onto the ILM even after the complete removal of the vitreous cortex during the initial vitrectomy.…”

Retinal detachment due to paravascular abnormalities-associated breaks in highly myopic eyes

“…Retinal detachment (RD) with posterior breaks in highly myopic eyes has been reported in previous studies [6][7][8]. However, whether the breaks were related to PVAs was never reported.…”

Retinal Detachment

“…In addition to peripheral retinal abnormalities, alterations of the vitreoretinal interface at the posterior pole play a role in the pathogenesis of RRD due to macular holes in highly myopic eyes. Less commonly, RRDs in highly myopic eyes are due to posterior retinal breaks that can easily escape diagnosis [ 26 ]. These typically have a linear shape, lie parallel to the adjacent retinal vessels of the posterior vascular arcades, and are almost exclusively located over areas of patchy chorioretinal atrophy.…”