Retinoschisis in eyes with pachychoroid and retinal pigment epithelial atrophy

  • Jiwon Baek
  • Jae Hyung Lee
  • Won Ki LeeEmail author
Retinal Disorders



To describe the clinical characteristics and courses for eyes with retinoschisis associated with pachychoroid.


A retrospective interventional case series study. Twenty-one eyes (18 patients) with pachychoroid that showed retinoschisis without evidence of neovascularization that had been followed for 1 year were included. Multimodal imaging, including fundus photography, spectral-domain optical coherence tomography (OCT) with an enhanced depth protocol, fluorescein angiography (FA), and indocyanine green angiography (ICGA), was provided and treatment outcomes were analyzed.


Focal RPE atrophy was present below or adjacent to the schisis in all eyes, and the mean atrophy area was 1.38 ± 1.37 mm2. Intraretinal fluids of the schisis originated from the atrophy area and involved the retinal layer which was correlated with the extent of outer retinal defect. Dilated Haller layer vessel and choroidal vascular hyperpermeability were observed under the area with atrophy in all eyes. After 1 year of treatment, 11 eyes (52%) still had fluid and 7 of them had fluid at the macula. Nonetheless, the mean central macular thickness decreased (144.4 to 121.8, P < 0.001), visual acuity improved (0.65 to 0.47, P = 0.026), and subfoveal choroidal thickness decreased (442.2 μm to 394.9 μm, P < 0.001).


Atrophy of RPE can cause retinoschisis in eyes with pachychoroid. The intraretinal fluid that originated from underlying choroid and choroidal thickness decreased as intraretinal fluid diminished.


Pachychoroid Retinoschisis RPE atrophy Intraretinal fluid Intraretinal cystic cavities Choroidal hyperpermeability 


Compliance with ethical standards

Conflict of interest

There are no conflicts of interest for any author of this article.

Financial disclosure(s)

Won Ki Lee has served on advisory boards for Novartis, Bayer, Allergan, Alcon, and Santen, and has received consultancy fees from these companies. He has received payments for lectures from Novartis, Bayer, Allergan and Alcon. Jiwon Baek and Jae Hyung Lee has no financial disclosures to report.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was waivered because of the retrospective design of the study.


  1. 1.
    Jain N, Johnson MW (2014) Pathogenesis and treatment of maculopathy associated with cavitary optic disc anomalies. Am J Ophthalmol 158(3):423–435. CrossRefPubMedGoogle Scholar
  2. 2.
    Shah SD, Yee KK, Fortun JA, Albini T (2014) Optic disc pit maculopathy: a review and update on imaging and treatment. Int Ophthalmol Clin 54(2):61–78. CrossRefPubMedGoogle Scholar
  3. 3.
    Choi YJ, Lee EJ, Kim BH, Kim TW (2014) Microstructure of the optic disc pit in open-angle glaucoma. Ophthalmology 121(11):2098–2106 e2092. CrossRefPubMedGoogle Scholar
  4. 4.
    Lee JH, Park HY, Baek J, Lee WK (2016) Alterations of the lamina cribrosa are associated with peripapillary retinoschisis in glaucoma and pachychoroid spectrum disease. Ophthalmology 123(10):2066–2076. CrossRefPubMedGoogle Scholar
  5. 5.
    Pang CE, Freund KB (2015) Pachychoroid neovasculopathy. Retina 35(1):1–9. CrossRefGoogle Scholar
  6. 6.
    Warrow DJ, Hoang QV, Freund KB (2013) Pachychoroid pigment epitheliopathy. Retina 33(8):1659–1672. CrossRefGoogle Scholar
  7. 7.
    Lee WK, Baek J, Dansingani KK, Lee JH, Freund KB (2016) Choroidal morphology in eyes with POLYPOIDAL choroidal vasculopathy and normal or subnormal SUBFOVEAL choroidal thickness. Retina.
  8. 8.
    Balaratnasingam C, Lee WK, Koizumi H, Dansingani K, Inoue M, Freund KB (2016) Polypoidal choroidal vasculopathy: a distinct disease or manifestation of many? Retina 36(1):1–8. CrossRefGoogle Scholar
  9. 9.
    Pautler SE, Browning DJ (2015) Isolated posterior uveal effusion: expanding the spectrum of the uveal effusion syndrome. Clin Ophthalmol 9:43–49. CrossRefPubMedGoogle Scholar
  10. 10.
    Dansingani KK, Balaratnasingam C, Klufas MA, Sarraf D, Freund KB (2015) Optical coherence tomography angiography of shallow irregular pigment epithelial detachments in pachychoroid spectrum disease. Am J Ophthalmol.
  11. 11.
    Dansingani KK, Balaratnasingam C, Naysan J, Freund KB (2016) EN face imaging of pachychoroid spectrum disorders with swept-source optical coherence tomography. Retina 36(3):499–516. CrossRefGoogle Scholar
  12. 12.
    Schmidt-Erfurth U, Leitgeb RA, Michels S, Povazay B, Sacu S, Hermann B, Ahlers C, Sattmann H, Scholda C, Fercher AF, Drexler W (2005) Three-dimensional ultrahigh-resolution optical coherence tomography of macular diseases. Invest Ophthalmol Vis Sci 46(9):3393–3402. CrossRefPubMedGoogle Scholar
  13. 13.
    Schmitz-Valckenberg S, Fleckenstein M, Gobel AP, Hohman TC, Holz FG (2011) Optical coherence tomography and autofluorescence findings in areas with geographic atrophy due to age-related macular degeneration. Invest Ophthalmol Vis Sci 52(1):1–6. CrossRefPubMedGoogle Scholar
  14. 14.
    Alasil T, Ferrara D, Adhi M, Brewer E, Kraus MF, Baumal CR, Hornegger J, Fujimoto JG, Witkin AJ, Reichel E, Duker JS, Waheed NK (2015) En face imaging of the choroid in polypoidal choroidal vasculopathy using swept-source optical coherence tomography. Am J Ophthalmol 159(4):634–643. CrossRefPubMedGoogle Scholar
  15. 15.
    Imamura Y, Fujiwara T, Margolis R, Spaide RF (2009) Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy. Retina 29(10):1469–1473. CrossRefGoogle Scholar
  16. 16.
    Jirarattanasopa P, Ooto S, Tsujikawa A, Yamashiro K, Hangai M, Hirata M, Matsumoto A, Yoshimura N (2012) Assessment of macular choroidal thickness by optical coherence tomography and angiographic changes in central serous chorioretinopathy. Ophthalmology 119(8):1666–1678. CrossRefGoogle Scholar
  17. 17.
    Guyer DR, Yannuzzi LA, Slakter JS, Sorenson JA, Ho A, Orlock D (1994) Digital indocyanine green videoangiography of central serous chorioretinopathy. Arch Ophthalmol 112(8):1057–1062CrossRefGoogle Scholar
  18. 18.
    Fujimoto H, Gomi F, Wakabayashi T, Sawa M, Tsujikawa M, Tano Y (2008) Morphologic changes in acute central serous chorioretinopathy evaluated by fourier-domain optical coherence tomography. Ophthalmology 115(9):1494–1500, 1500 e1491-1492. CrossRefGoogle Scholar
  19. 19.
    Wolter JR (1981) The histopathology of cystoid macular edema. Albrecht Von Graefes Arch Klin Exp Ophthalmol 216(2):85–101CrossRefGoogle Scholar
  20. 20.
    Antcliff RJ, Hussain AA, Marshall J (2001) Hydraulic conductivity of fixed retinal tissue after sequential excimer laser ablation: barriers limiting fluid distribution and implications for cystoid macular edema. Arch Ophthalmol 119(4):539–544CrossRefGoogle Scholar
  21. 21.
    Hata M, Oishi A, Tsujikawa A, Yamashiro K, Miyake M, Ooto S, Tamura H, Nakanishi H, Takahashi A, Yoshikawa M, Yoshimura N (2014) Efficacy of intravitreal injection of aflibercept in neovascular age-related macular degeneration with or without choroidal vascular hyperpermeability. Invest Ophthalmol Vis Sci 55(12):7874–7880. CrossRefPubMedGoogle Scholar
  22. 22.
    Maruko I, Iida T, Sugano Y, Ojima A, Ogasawara M, Spaide RF (2010) Subfoveal choroidal thickness after treatment of central serous chorioretinopathy. Ophthalmology 117(9):1792–1799. CrossRefPubMedGoogle Scholar
  23. 23.
    Kim YK, Ryoo NK, Woo SJ, Park KH (2015) Choroidal thickness changes after photodynamic therapy and recurrence of chronic central serous chorioretinopathy. Am J Ophthalmol 160(1):72–84.e71. CrossRefPubMedGoogle Scholar
  24. 24.
    Maruko I, Iida T, Sugano Y, Furuta M, Sekiryu T (2011) One-year choroidal thickness results after photodynamic therapy for central serous chorioretinopathy. Retina 31(9):1921–1927. CrossRefPubMedGoogle Scholar
  25. 25.
    Maruko I, Iida T, Oyamada H, Sugano Y, Ojima A, Sekiryu T (2013) Choroidal thickness changes after intravitreal ranibizumab and photodynamic therapy in recurrent polypoidal choroidal vasculopathy. Am J Ophthalmol 156(3):548–556. CrossRefGoogle Scholar
  26. 26.
    Mudvari SS, Goff MJ, Fu AD, McDonald HR, Johnson RN, Ai E, Jumper JM (2007) The natural history of pigment epithelial detachment associated with central serous chorioretinopathy. Retina 27(9):1168–1173. CrossRefPubMedGoogle Scholar
  27. 27.
    Bujarborua D (2001) Long-term follow-up of idiopathic central serous chorioretinopathy without laser. Acta Ophthalmol Scand 79(4):417–421CrossRefGoogle Scholar
  28. 28.
    Park DW, Schatz H, McDonald HR, Johnson RN (1997) Ring retinal pigment epithelial window defect of the macula in central serous chorioretinopathy. Retina 17(3):205–210CrossRefGoogle Scholar
  29. 29.
    Wang MS, Sander B, Larsen M (2002) Retinal atrophy in idiopathic central serous chorioretinopathy. Am J Ophthalmol 133(6):787–793CrossRefGoogle Scholar
  30. 30.
    Yannuzzi LA, Shakin JL, Fisher YL, Altomonte MA (2012) Peripheral retinal detachments and retinal pigment epithelial atrophic tracts secondary to central serous pigment epitheliopathy. 1984 Retina 32(Suppl 1):1554–1572PubMedGoogle Scholar
  31. 31.
    Cardillo Piccolino F, Eandi CM, Ventre L, Rigault de la Longrais RC, Grignolo FM (2003) Photodynamic therapy for chronic central serous chorioretinopathy. Retina 23(6):752–763CrossRefGoogle Scholar
  32. 32.
    Schutze C, Wedl M, Baumann B, Pircher M, Hitzenberger CK, Schmidt-Erfurth U (2015) Progression of retinal pigment epithelial atrophy in antiangiogenic therapy of neovascular age-related macular degeneration. Am J Ophthalmol 159(6):1100–1114 e1101. CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Nair U, Ganekal S, Soman M, Nair K (2012) Correlation of spectral domain optical coherence tomography findings in acute central serous chorioretinopathy with visual acuity. Clin Ophthalmol 6:1949–1954. CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Cheung CM, Yang E, Lee WK, Lee GK, Mathur R, Cheng J, Wong D, Wong TY, Lai TY (2015) The natural history of polypoidal choroidal vasculopathy: a multi-center series of untreated Asian patients. Graefes Arch Clin Exp Ophthalmol 253(12):2075–2085. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
  2. 2.Department of Ophthalmology, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
  3. 3.Retina CenterNune Eye HospitalSeoulRepublic of Korea

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