Retinoschisis in eyes with pachychoroid and retinal pigment epithelial atrophy
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.
KeywordsPachychoroid 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.
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.
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.
- 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. https://doi.org/10.1097/iae.0000000000001346
- 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. https://doi.org/10.1016/j.ajo.2015.08.028
- 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. https://doi.org/10.1167/iovs.05-0370 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1167/iovs.10-5619 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1016/j.ajo.2014.12.012 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1016/j.ophtha.2012.02.021 CrossRefGoogle Scholar
- 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. https://doi.org/10.1016/j.ophtha.2008.01.021 CrossRefGoogle Scholar
- 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. https://doi.org/10.1167/iovs.14-14610 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1016/j.ajo.2015.02.020 CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1007/s00417-015-2933-2 CrossRefPubMedGoogle Scholar