Peripapillary Retinoschisis in Glaucomatous Eyes

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Abstract

Purpose

To investigate the structural and clinical characteristics of peripapillary retinoschisis observed in glaucomatous eyes using spectral-domain optical coherence tomography (SD-OCT).

Methods

Circumpapillary retinal nerve fiber layer (cpRNFL) and macular cross-hair SD-OCT scans and infrared fundus images of the glaucoma patients from the Investigating Glaucoma Progression Study (IGPS) and healthy volunteers were reviewed. Optic disc images obtained using enhanced depth imaging (EDI) SD-OCT were also evaluated. The structural characteristics and clinical course of the retinoschisis associated with glaucoma were investigated.

Results

Twenty-five retinoschisis areas were found in 22 of the 372 patients (5.9%) included in the IGPS, and in 1 area in 1 of 187 healthy control subjects (0.5%). In the 22 glaucomatous eyes with retinoschisis, the schisis was attached to the optic disc and overlapped with the retinal nerve fiber layer (RNFL) defect. The RNFL was the layer most commonly affected by the retinoschisis, either alone or together with other deeper layers. Acquired optic disc pit was identified in 8 eyes on disc photography and/or B-scan images obtained by EDI SD-OCT. Spontaneous resolution of this condition was observed in nine eyes. No retinal detachment or macular involvement of the retinoschisis was observed in any of the eyes. Multivariate analysis showed a significant influence of a higher intraocular pressure at SD-OCT scanning on the presence of retinoschisis (Odds ratio = 1.418, P = 0.001).

Conclusions

The present study investigated 22 cases of peripapillary retinoschisis in glaucomatous eyes. The retinoschisis was attached to the optic nerve and topographically correlated with RNFL defect. It often resolved spontaneously without causing severe visual disturbance. Care should be taken not to overestimate the RNFL thickness in eyes with retinoschisis, and also not to misinterpret the resolution of retinoschisis as a rapid glaucomatous RNFL deterioration.

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Most cited references 31

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Optic disc pit: a review.

Ilias Georgalas, Petros Petrou, Gerasimos Georgopoulos … (2011)

Since Wiethe first described the clinical presentation of two optic disc depressions in a 62-year-old woman in 1882, there have been many studies addressing what later become known as the "optic disc pit." The main complication of this condition, termed optic disc pit maculopathy, is associated with visual deterioration. Treatment of optic disc pit maculopathy remains challenging. Here we review the body of literature that documents the clinical findings, pathophysiology, histology, main complications, treatment options, special features and presentations, and differential diagnosis of optic disc pit. The source of the intraretinal fluid in optic disc pit maculopathy remains controversial. Four possible sources of this fluid have been proposed: fluid from the vitreous cavity; cerebrospinal fluid originating from the subarachnoid space; fluid from leaky blood vessels at the base of the pit; and fluid from the orbital space surrounding the dura. Optic disc pits are a very rare clinical entity, affecting approximately one in 11,000 people. Patients with congenital optic disc pit sometimes remain asymptomatic, but 25% to 75% present with visual deterioration in their 30s or 40s after developing macular schisis and detachment. The most widely accepted treatment for such patients is a surgical approach involving pars plana vitrectomy with or without internal limiting membrane peeling, with or without endolaser photocoagulation and C3F8 endotamponade.

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Enhanced depth imaging optical coherence tomography of deep optic nerve complex structures in glaucoma.

Sung Park, Carlos De Moraes, Christopher C Teng … (2012)

To assess the usefulness of enhanced depth imaging (EDI) optical coherence tomography (OCT) for evaluating deep structures of the optic nerve complex (ONC; optic nerve head and peripapillary structures) in glaucoma. Prospective, observational study. Seventy-three established glaucoma patients (139 eyes) with a range of glaucomatous damage. Serial horizontal and vertical EDI OCT images of the ONC were obtained from both eyes of each participant. Deep ONC structures, including the lamina cribrosa (LC), short posterior ciliary artery (SPCA), central retinal artery (CRA), central retinal vein (CRV), peripapillary choroid and sclera, and subarachnoid space around the optic nerve, were investigated for their visibility and morphologic features. Deep ONC structures identified in EDI OCT images. Visual field mean deviation of 139 included eyes was -11.8 ± 8.6 dB (range, -28.70 to -2.01 dB). The anterior laminar surface was identified in all eyes in the central laminar area and in 91 (65%) eyes in the periphery beneath the neuroretinal and scleral rims or vascular structures. The LC pores with various shapes and sizes were visualized in 106 (76%) eyes, mainly in the central and temporal areas of the LC. Localized LC lesions seen on optic disc photographs were identified as focal LC defects (partial loss of LC tissue) in the EDI OCT images. The locations of the CRA and CRV were identified in all eyes. In the LC, the CRA maintained a straight shape with a consistent caliber, but the CRV (and tributaries) assumed a more irregular shape. The SPCAs, their branches through the emissary canals in the sclera, or both were visualized in 120 (86%) eyes. The subarachnoid space around the optic nerve was identified with varying degrees of clarity in 25 eyes (18%): 17 had high myopia and extensive parapapillary atrophy. Intrachoroidal cavitation or choroidal schisis, which had been unrecognized clinically, was identified in 2 eyes (1%) with high myopia. Enhanced depth imaging OCT was able to visualize a wide variety of deep ONC structures in glaucoma patients and may be helpful in detecting, conceptualizing, and understanding basic and complicated in vivo anatomic and pathologic features of the ONC in glaucoma. Proprietary or commercial disclosure may be found after the references. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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Intracranial migration of silicone oil from an eye with optic pit.

V Mester, Csilla Szabo, F Kuhn … (2006)

The origin of subretinal fluid in eyes with optic pit remains controversial. Case report. The authors found that silicone oil, implanted into an eye that developed proliferative vitreoretinopathy after surgery for optic pit-related macular detachment, has migrated into the subarachnoid space. As this case shows, cerebrospinal fluid may migrate into the submacular space in eyes with optic pits.

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Author and article information

Contributors

Jost B. Jonas: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2014

Publication date (Electronic): 28 February 2014

Volume: 9

Issue: 2

Electronic Location Identifier: e90129

Affiliations

[1]Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

Medical Faculty Mannheim of the University of Heidelberg, Germany

Author notes

* E-mail: twkim7@ 123456snu.ac.kr

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: EJL TWK. Performed the experiments: EJL TWK MK YJC. Analyzed the data: EJL TWK MK YJC. Contributed reagents/materials/analysis tools: EJL TWK. Wrote the paper: EJL TWK.

Article

Publisher ID: PONE-D-13-39693

DOI: 10.1371/journal.pone.0090129

PMC ID: 3938601

PubMed ID: 24587238

SO-VID: 16e365b3-5d7d-4a10-bd2f-6f40da02a080

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 26 September 2013

Date accepted : 27 January 2014

Page count

Pages: 9

Funding

This study was supported by a National Research Foundation of Korea Grant funded by the Korean Government (800-20130242). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Peripapillary Retinoschisis in Glaucomatous Eyes

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Abstract

Purpose

Methods

Results

Conclusions

Related collections

PLOS Climate

Most cited references 31

Optic disc pit: a review.

Enhanced depth imaging optical coherence tomography of deep optic nerve complex structures in glaucoma.

Intracranial migration of silicone oil from an eye with optic pit.

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