[Skip to Navigation]
JAMA Ophthalmology Clinical Challenge
September 2, 2021

New-Onset Macular Schisis in a Patient With Glaucoma

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, Washington University in St Louis, St Louis, Missouri
  • 2Department of Developmental Biology, Washington University in St Louis, St Louis, Missouri
  • 3Department of Medicine, Washington University in St Louis, St Louis, Missouri
JAMA Ophthalmol. 2021;139(11):1236-1237. doi:10.1001/jamaophthalmol.2021.0939

A 70-year-old woman with an ocular history of primary open-angle glaucoma on latanoprost, bilateral trabeculectomies, and argon laser trabeculoplasties presented with several months of worsening vision in the left eye. On examination, her best-corrected distance visual acuity was 20/40 OD and 20/60 OS (baseline 20/40 OU). Pupils were equally round and reactive, without afferent pupillary defect. Findings of Amsler grid testing were notable for a small area of distortion inferiorly in the left eye. Intraocular pressures (IOPs) were 13 mm Hg in both eyes. Findings of anterior segment examination were unremarkable. Findings of dilated fundus examination were notable for cup-disc ratio of 0.9 in the right eye and 0.85 in the left eye with temporal thinning, stable from prior, and new intraretinal thickening in the left eye. Optical coherence tomography (OCT) imaging of the left eye revealed schiticlike separation of the outer plexiform and outer nuclear layers extending from the temporal edge of the optic nerve head to the fovea (Figure 1A), continuous with the peripapillary nerve sheath.

Add or change institution