Acta Ophthalmologica 2015
Spontaneous resolution of peripapillary retinoschisis associated with glaucomatous optic neuropathy
in eyes with enlarged optic disc cups but without congenital optic disc pits (Hollander et al. 2005; Kahook et al. 2007). We report an eye with peripapillary retinoschisis associated with glaucomatous optic neuropathy and normal IOP.
A 53-year-old woman visited a local clinic for visual field defect in her right eye associated with headaches and periorbital pain. She was referred to our clinic on September 2008. She was diagnosed with borderline glaucoma earlier. Her visual acuity was 20/20 in
Makoto Inoue,1 Yuji Itoh,1 Tosho Rii,1,2 Yoshiyuki Kita,1 Kazunari Hirota,1 Daisuke Kunita1 and Akito Hirakata1 1 Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan; 2 Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
doi: 10.1111/aos.12568
Editor, ptic disc pits are congenital anomalies of the optic nerve head and are commonly associated with retinoschisis and serous retinal detachment. Macular or peripapillary retinoschisis can develop after an acute increase of intraocular pressure (IOP)
O
Fig. 1. Fundus and optical coherence tomographic (OCT) images. (A) Fundus photograph of the right eye at the initial visit shows peripapillary retinoschisis (white arrowheads) and neuroretinal rim narrowing with a retinal nerve fibre layer (RNFL) defect (arrowheads). (B) Magnified photograph of the optic disc of the left eye shows the neuroretinal rim narrowing and the RNFL defect (arrowheads). (C) Fundus photograph 15 months after the initial visit showing a temporal shift to the macular retinoschisis (white arrowheads). (D) Fundus photograph 3 years after the initial visit shows complete resolution of the macular retinoschisis (white arrowheads). (E) Magnified photograph of the right eye (A) at the initial visit shows the RNFL defect (arrowheads) and tortuous vessels (arrows) at the cupped disc (F) Magnified photograph of the right eye (D) after 3 years shows the RNFL defect (arrowheads) and more tortuous vessels (arrows) at the neuroretinal rim narrowing after a resolution of schisis within the disc. (G) Horizontal OCT scan across the macula at the initial visit shows retinoschisis (arrow) at the temporal edge of the optic disc, and retinal detachment with a schisis-like structure at the cupped disc (arrowhead) (H) Horizontal OCT scan across the macula 3 years after the initial visit shows resolution of retinoschisis and retinal detachment with partial posterior vitreous detachment (black arrowheads) and liquefied cavity above the optic disc (black arrow). The schisis-like structure (white arrowheads) above the optic disc remains. Scale bars = 1 mm.
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(B)
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(D)
(E)
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Acta Ophthalmologica 2015
both eyes, and the refractive error was –1.0 D OD and –0.25 D OS. Her IOP was 14 mmHg OD and 15 mmHg OS. Ophthalmoscopy revealed bilateral neuroretinal rim narrowing at the optic disc margin, inferior retinal nerve fibre layer (RNFL) defect and peripapillary retinoschisis without a posterior vitreous detachment in the right eye with normal open anterior chamber angle (Fig. 1). Fluorescein angiography showed no leakage or any signs of an optic disc pit. Optical coherence tomography (OCT, OCT3-STRATUS, Carl Zeiss Meditec) revealed peripapillary retinoschisis and retinal detachment. Humphrey field analyzer (Humphrey- Zeiss System) showed a superior Bjerrum scotoma corresponding to the inferior RNFL defect in both eyes. She was followed without any treatment because of her good vision. The headaches and periorbital pain disappeared after 1 month. She noticed that the paracentral scotoma had moved gradually towards the central visual field, and the peripapillary retinoschisis turned to macular retinoschisis at 15 months but she maintained good vision of 20/20. The macular retinoschisis completely resolved after 3 years without any recurrence for 2 years. Vision was maintained at 20/20 without a central scotoma. The IOP remained within the normal range without any topical medication and no progression of the visual field defect was detected. Spectral domain OCT (Cirrus-HD-OCT, Carl Zeiss Meditec) showed a resolution of the macular retinoschisis with partially detachment of the posterior vitreous cortex. The optic disc cup was deeper corresponding to the resolution of the peripapillary retinoschisis and schisis within the optic disc. Kahook et al. (2007) described two cases of peripapillary retinoschisis associated with increased IOP and angle-closure glaucoma. An acute elevation of the IOP can lead to structural defects in the optic nerve head and peripapillary retinoschisis as seen in cases of optic disc pit maculopathy. Zumbro et al. (2007) reported that vitreous surgery can resolve a retinoschisis associated with an enlarged optic disc cup. They reported that vitreous traction may have played a role in the development of the macular retinoschisis and foveal detachment. Zhao & Li (2011) described a case of
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macular retinoschisis that developed in an eye with normal tension glaucoma. They also suggested that vitreous traction was the cause of the retinoschisis near the RNFL defect, and the foveal detachment developed by the seeping of fluid through the intraretinal spaces. The IOP was normal as in our patient, and vitreous traction probably caused the peripapillary and macular retinoschisis that resolved spontaneously when the posterior vitreous cortex was partially detached. Hwang et al. (2014) described a case of peripapillary retinoschisis within the retinal nerve fibre, ganglion cell and inner plexiform layers detected in the OCT images of 19 glaucomatous eyes. However, none of the eyes developed macular retinoschisis, and the peripapillary retinoschisis resolved without any treatment. Our patient developed symptomatic peripapillary retinoschisis and retinal detachment which expanded to macular retinoschisis. Thus, peripapillary retinoschisis associated with glaucomatous optic neuropathy can progress to macular retinoschisis which can resolve spontaneously by a partial vitreous detachment.
References Hollander DA, Barricks ME, Duncan JL & Irvine AR (2005): Macular schisis detachment associated with angle-closure glaucoma. Arch Ophthalmol 123: 270–272. Hwang YH, Kim YY, Kim HK & Sohn YH (2014): Effect of peripapillary retinoschisis on retinal nerve fibre layer thickness measurement in glaucomatous eyes. Br J Ophthalmol 98: 669–674. Kahook MY, Noecker RJ, Ishikawa H et al. (2007): Peripapillary schisis in glaucoma patients with narrow angles and increased intraocular pressure. Am J Ophthalmol 143: 697–699. Zhao M & Li X (2011): Macular retinoschisis associated with normal tension glaucoma. Graefes Arch Clin Exp Ophthalmol 249: 1255–1258. Zumbro DS, Jampol LM, Folk JC, Olivier MM & Anderson-Nelson S (2007): Macular schisis and detachment associated with presumed acquired enlarged optic nerve head cups. Am J Ophthalmol 144: 70–74.
Correspondence: Makoto Inoue, MD Kyorin Eye Center Kyorin University, School of Medicine 6-20-2 Shinkawa
Mitaka, Tokyo 181-8611, Japan Tel: +81 422 475511, ext.2606 Fax: +81 422 469309 Email: [email protected]
Metamorphopsia and interocular suppression in monocular and binocular maculopathy Emily Wiecek,1,2,3 Kameran Lashkari,1,2 Steven C. Dakin3,4,5 and Peter Bex1,2,6 1
Schepens Eye Research Institute/ Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; 2 Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; 3Institute of Ophthalmology, University College London, London, UK; 4National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, London, UK; 5 Department of Optometry & Vision Science, University of Auckland, New Zealand; 6Department of Psychology, Northeastern University, Boston, Massachusetts, USA doi: 10.1111/aos.12559
Editor,
M
etamorphopsia is a key symptom of macular disease, particularly age-related macular degeneration (AMD) (De Jong 2006), that is often measured with Amsler grids at home and in the clinic, even though the test lacks both sensitivity and specificity (Schuchard 1993; Crossland & Rubin 2007). We address issues of monocular viewing and fixation compliance with a computerized version of the Amsler grid and binocular eyetracking. Control of monocular viewing and compliant fixation enabled accurate quantification of the area and location of metamorphopsia in each eye. An eight-item questionnaire was administered to assess metamorphopsia patient reported outcomes (Alster et al. 2005; Arimura et al. 2011), and we measured interocular suppression with a dichoptic task with stereo shutter glasses. All participants were recruited with the criterion of no reported foveal vision loss and binoc-
Spontaneous resolution of peripapillary retinoschisis associated with glaucomatous optic neuropathy
in eyes with enlarged optic disc cups but without congenital optic disc pits (Hollander et al. 2005; Kahook et al. 2007). We report an eye with peripapillary retinoschisis associated with glaucomatous optic neuropathy and normal IOP.
A 53-year-old woman visited a local clinic for visual field defect in her right eye associated with headaches and periorbital pain. She was referred to our clinic on September 2008. She was diagnosed with borderline glaucoma earlier. Her visual acuity was 20/20 in
Makoto Inoue,1 Yuji Itoh,1 Tosho Rii,1,2 Yoshiyuki Kita,1 Kazunari Hirota,1 Daisuke Kunita1 and Akito Hirakata1 1 Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan; 2 Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
doi: 10.1111/aos.12568
Editor, ptic disc pits are congenital anomalies of the optic nerve head and are commonly associated with retinoschisis and serous retinal detachment. Macular or peripapillary retinoschisis can develop after an acute increase of intraocular pressure (IOP)
O
Fig. 1. Fundus and optical coherence tomographic (OCT) images. (A) Fundus photograph of the right eye at the initial visit shows peripapillary retinoschisis (white arrowheads) and neuroretinal rim narrowing with a retinal nerve fibre layer (RNFL) defect (arrowheads). (B) Magnified photograph of the optic disc of the left eye shows the neuroretinal rim narrowing and the RNFL defect (arrowheads). (C) Fundus photograph 15 months after the initial visit showing a temporal shift to the macular retinoschisis (white arrowheads). (D) Fundus photograph 3 years after the initial visit shows complete resolution of the macular retinoschisis (white arrowheads). (E) Magnified photograph of the right eye (A) at the initial visit shows the RNFL defect (arrowheads) and tortuous vessels (arrows) at the cupped disc (F) Magnified photograph of the right eye (D) after 3 years shows the RNFL defect (arrowheads) and more tortuous vessels (arrows) at the neuroretinal rim narrowing after a resolution of schisis within the disc. (G) Horizontal OCT scan across the macula at the initial visit shows retinoschisis (arrow) at the temporal edge of the optic disc, and retinal detachment with a schisis-like structure at the cupped disc (arrowhead) (H) Horizontal OCT scan across the macula 3 years after the initial visit shows resolution of retinoschisis and retinal detachment with partial posterior vitreous detachment (black arrowheads) and liquefied cavity above the optic disc (black arrow). The schisis-like structure (white arrowheads) above the optic disc remains. Scale bars = 1 mm.
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
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Acta Ophthalmologica 2015
both eyes, and the refractive error was –1.0 D OD and –0.25 D OS. Her IOP was 14 mmHg OD and 15 mmHg OS. Ophthalmoscopy revealed bilateral neuroretinal rim narrowing at the optic disc margin, inferior retinal nerve fibre layer (RNFL) defect and peripapillary retinoschisis without a posterior vitreous detachment in the right eye with normal open anterior chamber angle (Fig. 1). Fluorescein angiography showed no leakage or any signs of an optic disc pit. Optical coherence tomography (OCT, OCT3-STRATUS, Carl Zeiss Meditec) revealed peripapillary retinoschisis and retinal detachment. Humphrey field analyzer (Humphrey- Zeiss System) showed a superior Bjerrum scotoma corresponding to the inferior RNFL defect in both eyes. She was followed without any treatment because of her good vision. The headaches and periorbital pain disappeared after 1 month. She noticed that the paracentral scotoma had moved gradually towards the central visual field, and the peripapillary retinoschisis turned to macular retinoschisis at 15 months but she maintained good vision of 20/20. The macular retinoschisis completely resolved after 3 years without any recurrence for 2 years. Vision was maintained at 20/20 without a central scotoma. The IOP remained within the normal range without any topical medication and no progression of the visual field defect was detected. Spectral domain OCT (Cirrus-HD-OCT, Carl Zeiss Meditec) showed a resolution of the macular retinoschisis with partially detachment of the posterior vitreous cortex. The optic disc cup was deeper corresponding to the resolution of the peripapillary retinoschisis and schisis within the optic disc. Kahook et al. (2007) described two cases of peripapillary retinoschisis associated with increased IOP and angle-closure glaucoma. An acute elevation of the IOP can lead to structural defects in the optic nerve head and peripapillary retinoschisis as seen in cases of optic disc pit maculopathy. Zumbro et al. (2007) reported that vitreous surgery can resolve a retinoschisis associated with an enlarged optic disc cup. They reported that vitreous traction may have played a role in the development of the macular retinoschisis and foveal detachment. Zhao & Li (2011) described a case of
e318
macular retinoschisis that developed in an eye with normal tension glaucoma. They also suggested that vitreous traction was the cause of the retinoschisis near the RNFL defect, and the foveal detachment developed by the seeping of fluid through the intraretinal spaces. The IOP was normal as in our patient, and vitreous traction probably caused the peripapillary and macular retinoschisis that resolved spontaneously when the posterior vitreous cortex was partially detached. Hwang et al. (2014) described a case of peripapillary retinoschisis within the retinal nerve fibre, ganglion cell and inner plexiform layers detected in the OCT images of 19 glaucomatous eyes. However, none of the eyes developed macular retinoschisis, and the peripapillary retinoschisis resolved without any treatment. Our patient developed symptomatic peripapillary retinoschisis and retinal detachment which expanded to macular retinoschisis. Thus, peripapillary retinoschisis associated with glaucomatous optic neuropathy can progress to macular retinoschisis which can resolve spontaneously by a partial vitreous detachment.
References Hollander DA, Barricks ME, Duncan JL & Irvine AR (2005): Macular schisis detachment associated with angle-closure glaucoma. Arch Ophthalmol 123: 270–272. Hwang YH, Kim YY, Kim HK & Sohn YH (2014): Effect of peripapillary retinoschisis on retinal nerve fibre layer thickness measurement in glaucomatous eyes. Br J Ophthalmol 98: 669–674. Kahook MY, Noecker RJ, Ishikawa H et al. (2007): Peripapillary schisis in glaucoma patients with narrow angles and increased intraocular pressure. Am J Ophthalmol 143: 697–699. Zhao M & Li X (2011): Macular retinoschisis associated with normal tension glaucoma. Graefes Arch Clin Exp Ophthalmol 249: 1255–1258. Zumbro DS, Jampol LM, Folk JC, Olivier MM & Anderson-Nelson S (2007): Macular schisis and detachment associated with presumed acquired enlarged optic nerve head cups. Am J Ophthalmol 144: 70–74.
Correspondence: Makoto Inoue, MD Kyorin Eye Center Kyorin University, School of Medicine 6-20-2 Shinkawa
Mitaka, Tokyo 181-8611, Japan Tel: +81 422 475511, ext.2606 Fax: +81 422 469309 Email: [email protected]
Metamorphopsia and interocular suppression in monocular and binocular maculopathy Emily Wiecek,1,2,3 Kameran Lashkari,1,2 Steven C. Dakin3,4,5 and Peter Bex1,2,6 1
Schepens Eye Research Institute/ Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; 2 Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; 3Institute of Ophthalmology, University College London, London, UK; 4National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, London, UK; 5 Department of Optometry & Vision Science, University of Auckland, New Zealand; 6Department of Psychology, Northeastern University, Boston, Massachusetts, USA doi: 10.1111/aos.12559
Editor,
M
etamorphopsia is a key symptom of macular disease, particularly age-related macular degeneration (AMD) (De Jong 2006), that is often measured with Amsler grids at home and in the clinic, even though the test lacks both sensitivity and specificity (Schuchard 1993; Crossland & Rubin 2007). We address issues of monocular viewing and fixation compliance with a computerized version of the Amsler grid and binocular eyetracking. Control of monocular viewing and compliant fixation enabled accurate quantification of the area and location of metamorphopsia in each eye. An eight-item questionnaire was administered to assess metamorphopsia patient reported outcomes (Alster et al. 2005; Arimura et al. 2011), and we measured interocular suppression with a dichoptic task with stereo shutter glasses. All participants were recruited with the criterion of no reported foveal vision loss and binoc-
