Skip to main content

Advertisement

SpringerLink
Log in

Macular retinoschisis associated with glaucomatous optic neuropathy in eyes with normal intraocular pressure

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate the clinical features, optical coherence tomography (OCT) findings, and surgical outcomes of eyes with macular retinoschisis associated with glaucomatous optic neuropathy and normal intraocular pressure (IOP).

Methods

In this retrospective interventional observational study, 11 eyes of 11 patients who underwent pars plana vitrectomy for macular retinoschisis and glaucomatous optic neuropathy were studied. All eyes had a vertical cup-to-disc ratio of ≥0.7 and retinal nerve fiber layer (RNFL) defects. Intraocular pressure (IOP) was <21 mmHg in all eyes, and there was no presence of congenital optic disc pits or high myopia in any eyes. The best-corrected visual acuity (BCVA) and the appearance of the fundus and OCT images were evaluated.

Results

The retinoschisis extended from the optic disc to the macula in all 11 eyes, and foveal detachment was present in 10 eyes. OCT showed vitreous adhesions near the RNFL defects and over the retinal vessels. The retinoschisis in the RNFL resolved immediately after the vitrectomy, and the BCVA improved significantly (p = 0.004). Macular retinoschisis resolved or decreased in all cases, although it required an average of 11 ± 3 months. The optic disc cup and RNFL defects were more clearly visible after resolution of the retinoschisis.

Conclusions

Macular retinoschisis can develop from vitreous traction near the RNFL defect in eyes with glaucomatous optic neuropathy and normal IOP. We suggest that the traction on the structurally fragile RNFL contributed to the retinoschisis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Bartz-Schmidt KU, Heimann K (1995) Pathogenesis of retinal detachment associated with morning glory disc. Int Ophthalmol 19:35–38

    Article  CAS  PubMed  Google Scholar 

  2. Brown GC, Shields JA, Goldberg RE (1980) Congenital pits of the optic nerve head II Clinical studies in humans. Ophthalmology 87:51–65

    Article  CAS  PubMed  Google Scholar 

  3. Christoforidis JB, Terrell W, Davidorf FH (2012) Histopathology of optic nerve pit-associated maculopathy. Clin Ophthalmol 6:1169–1174

    Article  PubMed Central  PubMed  Google Scholar 

  4. Coll GE, Chang S, Flynn TE, Brown GC (1995) Communication between the subretinal space and the vitreous cavity in the morning glory syndrome. Graefes Arch Clin Exp Ophthalmol 233:441–443

    Article  CAS  PubMed  Google Scholar 

  5. Doubal FN, MacLullich AM, Ferguson KJ, Dennis MS, Wardlaw JM (2010) Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease. Stroke 41:450–454

    Article  PubMed  Google Scholar 

  6. Farjad H, Besada E, Frauens BJ (2010) Peripapillary schisis with serous detachment in advanced glaucoma. Optom Vis Sci 87:205–217

    Article  Google Scholar 

  7. García-Arumí J, Guraya BC, Espax AB, Castillo VM, Ramsay LS, Motta RM (2004) Optical coherence tomography in optic pit maculopathy managed with vitrectomy-laser-gas. Graefes Arch Clin Exp Ophthalmol 242:819–826

    Article  PubMed  Google Scholar 

  8. Gass JD (1969) Serous detachment of the macula. Secondary to congenital pit of the optic nervehead. Am J Ophthalmol 67:821–841

    Article  CAS  PubMed  Google Scholar 

  9. Giarelli L, Falconieri G, Cameron JD, Pheley AM (2003) Schnabel cavernous degeneration: a vascular change of the aging eye. Arch Pathol Lab Med 127:1314–1319

    PubMed  Google Scholar 

  10. Hasegawa T, Akiba J, Ishiko S, Hikichi T, Kakehashi A, Hirokawa H, Yoshida A (1997) Abnormal vitreous structure in optic nerve pit. Jpn J Ophthalmol 41:324–327

    Article  CAS  PubMed  Google Scholar 

  11. Hirakata A, Okada AA, Hida T (2005) Long-term results of vitrectomy without laser treatment for macular detachment associated with an optic disc pit. Ophthalmology 112:1430–1435

    Article  PubMed  Google Scholar 

  12. Hirakata A, Inoue M, Hiraoka T, McCuen BW II (2012) Vitrectomy without laser treatment or gas tamponade for macular detachment associated with an optic disc pit. Ophthalmology 119:810–818

    Article  PubMed  Google Scholar 

  13. Hiraoka T, Inoue M, Ninomiya Y, Hirakata A (2010) Infrared and fundus autofluorescence imaging in eyes with optic pit maculopathy. Clin Experiment Ophthalmol 38:669–677

    Article  PubMed  Google Scholar 

  14. Ho TC, Chen MS, Huang JS, Shih YF, Ho H, Huang YH (2012) Foveola nonpeeling technique in internal limiting membrane peeling of myopic foveoschisis surgery. Retina 32:631–634

    PubMed  Google Scholar 

  15. Hollander DA, Barricks ME, Duncan JL, Irvine AR (2005) Macular schisis detachment associated with angle-closure glaucoma. Arch Ophthalmol 123:270–272

    Article  PubMed  Google Scholar 

  16. Honkanen RA, Jampol LM, Fingert JH, Moore MD, Taylor CM, Stone EM, Alward WL (2007) Familial cavitary optic disk anomalies: clinical features of a large family with examples of progressive optic nerve head cupping. Am J Ophthalmol 143:788–794

    Article  PubMed  Google Scholar 

  17. Hubschman JP, Reddy S, Kaines A, Law S (2010) Nasal retinoschisis associated with glaucoma. Ophthalmic Surg Lasers Imaging. doi:10.3928/15428877-20100215-60

    Google Scholar 

  18. Hwang YH, Kim YY, Kim HK, Sohn YH (2014) Effect of peripapillary retinoschisis on retinal nerve fibre layer thickness measurement in glaucomatous eyes. Br J Ophthalmol 98:669–674

    Article  PubMed  Google Scholar 

  19. Kahook MY, Noecker RJ, Ishikawa H, Wollstein G, Kagemann L, Wojtkowski M, Duker JS, Srinivasan VJ, Fujimoto JG, Schuman JS (2007) Peripapillary schisis in glaucoma patients with narrow angles and increased intraocular pressure. Am J Ophthalmol 143:697–699

    Article  PubMed Central  PubMed  Google Scholar 

  20. Laud K, Visaetsilpanonta S, Yannuzzi LA, Spaide RF (2007) Autofluorescence imaging of optic pit maculopathy. Retina 27:116–119

    Article  PubMed  Google Scholar 

  21. Lincoff H, Lopez R, Kreissig I, Yannuzzi L, Cox M, Burton T (1988) Retinoschisis associated with optic nerve pits. Arch Ophthalmol 106:61–67

    Article  CAS  PubMed  Google Scholar 

  22. Lincoff H, Kreissig I (1998) Optical coherence tomography of pneumatic displacement of optic disc pit maculopathy. Br J Ophthalmol 82:367–372

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Mavrikakis E, Lam WC (2011) Macular schisis and detachment secondary to large optic nerve head cup: a newly recognized syndrome amenable to vitrectomy. Acta Ophthalmol 89:95–96

    Article  PubMed  Google Scholar 

  24. Meirelles RL, Aggio FB, Costa RA, Farah ME (2005) STRATUS optical coherence tomography in unilateral colobomatous excavation of the optic disc and secondary retinoschisis. Graefes Arch Clin Exp Ophthalmol 243:76–81

    Article  PubMed  Google Scholar 

  25. Schatz H, McDonald HR (1988) Treatment of sensory retinal detachment associated with optic nerve pit or coloboma. Ophthalmology 95:178–186

    Article  CAS  PubMed  Google Scholar 

  26. Shimada N, Sugamoto Y, Ogawa M, Takase H, Ohno-Matsui K (2012) Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy. Am J Ophthalmol 154:693–701

    Article  PubMed  Google Scholar 

  27. Shukla D, Kalliath J, Tandon M, Vijayakumar B (2012) Vitrectomy for optic disk pit with macular schisis and outer retinal dehiscence. Retina 32:1337–1342

    Article  PubMed  Google Scholar 

  28. Snead MP, James N, Jacobs PM (1991) Vitrectomy, argon laser, and gas tamponade for serous retinal detachment associated with an optic disc pit: a case report. Br J Ophthalmol 75:381–382

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Song IS, Shin JW, Shin YW, Uhm KB (2011) Optic disc pit with peripapillary retinoschisis presenting as a localized retinal nerve fiber layer defect. Korean J Ophthalmol 25:455–458

    Article  PubMed Central  PubMed  Google Scholar 

  30. Spaide RF, Costa DL, Huang SJ (2003) Macular schisis in a patient without an optic disk pit optical coherence tomographic findings. Retina 23:238–240

    Article  PubMed  Google Scholar 

  31. Sugar HS (1962) Congenital pits in the optic disc with acquired macular pathology. Am J Ophthalmol 53:307–311

    Article  CAS  PubMed  Google Scholar 

  32. Tantri A, Vrabec TR, Cu-Unjieng A, Frost A, Annesley WH Jr, Donoso LA (2004) X-linked retinoschisis: a clinical and molecular genetic review. Surv Ophthalmol 49:214–230

    Article  PubMed  Google Scholar 

  33. Theodossiadis PG, Grigoropoulos VG, Emfietzoglou J, Theodossiadis GP (2007) Vitreous findings in optic disc pit maculopathy based on optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 245:1311–1318

    Article  PubMed  Google Scholar 

  34. Ugurlu S, Weitzman M, Nduaguba C, Caprioli J (1998) Acquired pit of the optic nerve: a risk factor for progression of glaucoma. Am J Ophthalmol 125:457–464

    Article  CAS  PubMed  Google Scholar 

  35. Yoshikawa T, Nishimura T, Minamino K, Takahashi K (2013) A long-term follow-up of peripapillary retinoschisis with optic disc hypoplasia. Int Ophthalmol 33:425–428

    Article  PubMed  Google Scholar 

  36. Zhao M, Li X (2011) Macular retinoschisis associated with normal tension glaucoma. Graefes Arch Clin Exp Ophthalmol 249:1255–1258

    Article  PubMed  Google Scholar 

  37. Zumbro DS, Jampol LM, Folk JC, Olivier MM, Anderson-Nelson S (2007) Macular schisis and detachment associated with presumed acquired enlarged optic nerve head cups. Am J Ophthalmol 144:70–74

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors declare that no government or non-government financial support was involved in the work for this submission. Contributions of authors are as follows: management, analysis, interpretation, and preparation of data (MI, YI, TR, YK, KH, DK, AH); interpretation and preparation of the manuscript (MI, YI, RT, YK, AH). The study and data accumulation were carried out with approval from the Institutional Review Board of the Kyorin University School of Medicine, and conformed to the tenets of the Declaration of Helsinki. Informed consent for the research was obtained from all patients.

Disclosure

The authors have no proprietary or commercial interest in any materials discussed in these reported clinical observations or this article.

Author information

Authors and Affiliations

  1. Kyorin Eye Center, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Makoto Inoue, Yuji Itoh, Tosho Rii, Yoshiyuki Kita, Kazunari Hirota, Daisuke Kunita & Akito Hirakata

  2. Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

    Tosho Rii

Authors
  1. Makoto Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuji Itoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tosho Rii
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshiyuki Kita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazunari Hirota
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daisuke Kunita
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akito Hirakata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Makoto Inoue.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Inoue, M., Itoh, Y., Rii, T. et al. Macular retinoschisis associated with glaucomatous optic neuropathy in eyes with normal intraocular pressure. Graefes Arch Clin Exp Ophthalmol 253, 1447–1456 (2015). https://doi.org/10.1007/s00417-014-2830-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-014-2830-0

Keywords

Search

Navigation