Retinoschisis with a posterior margin encroaching the macula. Moderate-intensity laser photocoagulation has been placed posterior to the schisis cavity.
A neurosensory detachment has developed extending toward the macula. A, There is a large tear in the outer retina curvilinear and paralleling the posterior extent of the schisis cavity. B, Optical coherence tomography shows the schisis cavity, the inner retinal layer, and the tear in the outer retinal layer.
Johnson DL, Nieto JC, Ip MS. Retinal Detachment Due to an Outer Retinal Tear Following Laser Prophylaxis for Retinoschisis. Arch Ophthalmol. 2008;126(12):1775-1776. doi:10.1001/archopht.126.12.1775
We report a case of a schisis detachment due to a tear in the outer retina that occurred shortly after laser prophylaxis for retinoschisis. The clinical course and outcome are described.
A 55-year-old hyperopic man with no significant ocular history was seen in consultation for photopsias of the left eye and was found to have degenerative retinoschisis bilaterally. The patient was asymptomatic in his right eye. Best-corrected visual acuity was 20/20 OU. Anterior segment examination of both eyes revealed trace nuclear sclerosis. In both eyes, the schisis cavities were located inferotemporally and anterior to the equator. Observation was recommended. Thirteen months later, the retinoschisis in the right eye had progressed posteriorly to within 2 to 3 disc diameters from the fovea. There were no inner or outer wall holes identified in the right eye. The left eye had an appearance stable from that at the initial visit the year before. There was no posterior vitreous detachment in either eye. The patient received barrier laser treatment posterior to the retinoschisis in the right eye (Figure 1).
Seventeen days after the laser treatment, the patient stated that he began noticing a shadow in his vision superonasally in his right eye. He was found to have a neurosensory detachment emanating from the retinoschisis. A large tear in the outer retina had developed immediately anterior to the barrier laser and conformed to the curvilinear shape of the laser (Figure 2). The patient underwent pars plana vitrectomy, internal drainage of the schisis cavity and neurosensory detachment, endolaser treatment, and intraocular gas treatment.
Posterior extension of retinoschisis cavities without a neurosensory detachment has been reported to occur extremely rarely.1,2 According to natural history studies, most cases remain stable and rarely extend to involve the macula.2 No definitive guidelines exist for laser prophylaxis in these unusual circumstances.
Retinal detachment associated with retinoschisis is rare and is due to holes in the outer retinal layer. The extent of the detachment is limited by the finite amount of fluid contained within the schisis cavity, is usually confined to the area of retinoschisis, and is usually nonprogressive.3 Outer wall holes are found to be present in 11% to 56% of these eyes, and neurosensory detachment has been reported to occur in up to 58% of eyes affected by outer layer holes.2,4 There is no consensus about when to treat because many of these eyes will remain stable.
Our patient presented a therapeutic challenge. Our decision to treat was based on the posterior extension of the schisis cavity threatening the macula and on patient preference. Given the temporal relationship of the laser treatment to the development of the detachment, we theorized that the laser induced the outer retinal tear, which led to development of the neurosensory detachment.
Our case demonstrates that laser treatment of retinoschisis may be associated with retinal detachment due to the development of outer retinal layer defects.
Correspondence: Dr Johnson, Palmetto Retina Center, 124 Sunset Ct, West Columbia, SC 29169 (firstname.lastname@example.org).
Financial Disclosure: None reported.