Indirect ophthalmoscope perimetry in patients with retinal detachment or retinoschisis

Novel features of degenerative retinoschisis identified using ultra-widefield multicolor channels: A review of 139 eyes

BACKGROUND/OBJECTIVE

To utilize ultra-widefield multimodal imaging (Optos PLC) to describe novel findings in degenerative retinoschisis.

METHODS

This retrospective, non-comparative case series of degenerative retinoschisis received a waiver of consent from Advarra IRB, Protocol 00066379. Initial ultra-widefield pseudocolour, colour-separated, autofluorescence, and peripheral OCT imaging were analysed for characterizing features.

RESULTS

In total, 139 eyes were included. A hyporeflective reticular pattern associated with retinoschisis was seen on pseudocolour images in 39% of cases, but visible in 53% on green-separated images. Fine hyper-reflective foci were observed in 49%. In 27%, retinoschisis was confirmed with OCT.

CONCLUSIONS

Ultra-widefield pseudocolour and green-separated images are valuable for the diagnosis and characterization of degenerative retinoschisis. The findings described may prompt the evaluation of subtle retinoschisis with peripheral OCT.

Diagnosis and Management of Degenerative Retinoschisis and Related Complications

Degenerative retinoschisis is a common condition characterized by elevation of the inner layers of the peripheral retina. While uncomplicated retinoschisis (i.e. with no associated retinal layer breaks) is almost invariably a benign process, retinal detachment associated with isolated outer layer breaks (termed schisis-detachment) is fairly common. Historically, schisis-detachment has been treated with a variety of interventions ranging from retinopexy to intraocular surgery. Based on published descriptions of the natural history of the disease, these interventions are likely unnecessary in many cases and may place the patient's vision at unnecessary risk. Progressive symptomatic schisis-related retinal detachment, on the other hand, is a vision threatening condition that requires intervention. While clinical examination remains the mainstay of diagnosis, recent advances in multimodal imaging can provide supplemental information in subtle cases and may prove valuable for long-term disease monitoring. When evaluating patients with peripheral retinal elevation, it is important for ophthalmologists to make an accurate diagnosis and understand the risk-benefit ratio associated with intervention. Thus, we summarize the current literature on the natural history, clinical and imaging diagnosis, and surgical management of degenerative retinoschisis and its related complications.

Glaucoma Mimickers: A major review of causes, diagnostic evaluation, and recommendations

Background: Glaucoma is characterized by chronic progressive optic neuropathy with corresponding visual field changes, with or without raised intraocular pressure (IOP). When diagnosing glaucoma or monitoring its progression, the examiner has to rely on the appearance of the optic disc, characteristic retinal nerve fiber layer defects, and corresponding visual field defects. However, similar changes and symptoms may be observed in several other disorders of the optic nerve and retina that may mimic glaucoma, often leading to misdiagnosis. Methods and result: The consequences of misdiagnosis not only result in improper treatment that may impact vision but also would negatively affect the overall health, psychological well-being of the patient, and may have considerable economic implications.Conclusion: The current review describes various conditions that mimic glaucoma and the features that help differentiate these conditions from glaucoma.

Comparative Assessment of Widefield Fundus Autofluorescence Patterns in Retinoschisis and Retinal Detachment

Purpose:

This article characterizes widefield fundus autofluorescence (WF-FAF) patterns in retinoschisis (RS), retinal detachment (RD), and combined retinoschisis-detachment (RS/RD), and to correlate them with spectral-domain optical coherence tomography (SD-OCT) findings.

Methods:

A retrospective case series of 13 eyes with senile RS, RD, or RS/RD is presented. One eye underwent imaging of 2 areas within the retina, resulting in 14 data points. Independent, masked graders classified pathology on SD-OCT as RS, RD, or RS/RD and graded WF-FAF images for either hypoautofluorescent areas or mixed autofluorescence (AF) (hyper-AF, iso-AF, hyper-AF with hypo-AF, hyper-AF with iso-AF, or hypo-AF with iso-AF).

Results:

There was no statistically significant correlation between the autofluorescence pattern and the type of retinal abnormality ( P = .74).

Conclusions:

High variability was found in the characterization of WF-FAF in patients with RS and RD. SD-OCT remains the criterion-standard imaging modality in distinguishing RS from RD in clinically ambiguous cases.

Diagnosis of Peripheral Retinoschisis Using Ultrasound Biomicroscopy

BACKGROUND AND OBJECTIVE

Retinal imaging can help differentiate retinoschisis (RS) from retinal detachment (RD). This study describes new sonographic features of RS using ultrasound biomicroscopy (UBM) and evaluates their diagnostic value.

PATIENTS AND METHODS

Medical records of subjects diagnosed with RS and RD who underwent imaging prior to intervention were reviewed. Images were evaluated for detachment shape ultrasound (US) B-mode, as well as presence of intraretinal pillars, retinal layers split, and intraretinal cysts on UBM.

RESULTS

Of 48 eyes from 48 patients in the study, 25 were diagnosed as RS and 23 as RD. "Retinal layers split" was the most common UBM finding in the RS group (72%), followed by intraretinal pillars (64%) and intraretinal cysts (36%). No RD case exhibited these findings (P < .001).

CONCLUSIONS

UBM might assist in difficult cases to differentiate between RS and RD by detection of the unique sonographic features of RS described herein. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e196-e202.].

Senile retinoschisis versus retinal detachment, the additional value of peripheral retinal OCT scans (SL SCAN-1, Topcon)

PURPOSE

A peripheral senile retinoschisis is sometimes difficult to distinguish from a retinal detachment by biomicroscopy alone. This study evaluated spectral domain OCT (SD-OCT) scans of the far peripheral retina to improve the differentiation between these diseases.

METHODS

Patients were included in whom the distinction between retinal detachment and senile retinoschisis was not clear based on biomicroscopy alone, or who had a presumed clinical diagnosis of senile retinoschisis. OCT scans were made with the SLSCAN-1, through a hand-held lens and a 3-mirror contact lens, while the area of interest was simultaneously observed with the slit lamp. The SLSCAN-1 is a SD-OCT integrated into a slit lamp, superluminescent diode light source with a central wavelength of 830 nm, bandwidth 30 nm, scan resolution 8-9 μm in tissue, scan depth 2 mm, scan speed 5000 A-scans per second.

RESULTS

In the 11 patients with an uncertain diagnosis, OCT scans showed a senile retinoschisis in four and a retinal detachment in seven patients. Fifteen of the 18 patients with a presumed diagnosis of retinoschisis showed a retinoschisis on OCT. In five of them, the OCT scans revealed a schisis detachment. Interestingly, three of the 18 patients had a retinal detachment.

CONCLUSION

Senile retinoschisis may mimic a peripheral retinal detachment and vice versa. Differentiation is important with respect to therapeutic decisions. OCT scans of the far peripheral retina, which can be made with the SLSCAN-1 through a 3-mirror contact lens, can contribute significantly to this differentiation. The obtained scans of the far peripheral retina clearly visualize the anatomic differences between both diseases.

Use of spectral-domain optical coherence tomography to differentiate acquired retinoschisis from retinal detachment in difficult cases

PURPOSE

This study presents a series of 10 patients who posed a diagnostic challenge regarding the diagnosis of acquired retinoschisis (RS) or retinal detachment (RD), where spectral-domain optical coherence tomography (OCT) with the Spectralis HRA and OCT device (Heidelberg Engineering, Heidelberg, Germany) was able to help make a correct diagnosis.

METHODS

Ten patients (five with acquired RS and five with RD) were referred to a vitreoretinal clinic at Moorfields Eye Hospital for definitive diagnosis and further management. All patients underwent scans with the Spectralis HRA and OCT device.

RESULTS

The Spectralis HRA and OCT was able to make a clear diagnosis of RS or RD in all patients. Of the five patients with RS confirmed on OCT, two were referred with RD, and of the five patients with RD, four were referred with RS. New OCT features of RS include the double schisis cavity phenomenon, intraretinal pillars through the schisis cavity, and irregularity of the inner surface of the attached outer leaf.

CONCLUSION

Spectral-domain OCT is a useful tool in distinguishing RS from RD, eliminating previous diagnostic uncertainty. The Spectralis HRA and OCT device has the added advantages of being able to reliably image anterior retinal pathology and produce high-definition images.

Optical Coherence Tomography Findings in Patients with Degenerative Retinoschisis and Symptomatic Retinal Detachment

This article describes the optical coherence tomography (OCT) findings in 4 patients with degenerative retinoschisis and symptomatic retinal detachment. All patients underwent pars plana vitrectomy, fluid gas exchange, and endolaser treatment. The OCT appearance of retinoschisis and visual outcomes were variable. OCT appears to be useful in understanding the anatomy and extent of the retinoschisis, especially in cases associated with retinal detachment.

A modified laser test for the identification of retinoschisis

PURPOSE

To describe a modified laser technique for identification of bullous retinoschisis.

DESIGN

Retrospective interventional case series collected over 10 years.

METHODS

Forty-one eyes with presumed bullous retinoschisis and breaks in the inner layers underwent a low-energy argon green laser application at the same energy as a control spot in adjacent retina. A gray response in the outer layers equal to the control spot was diagnostic of retinoschisis.

RESULTS

The laser test was positive for retinoschisis in 40 of 41 eyes. In none of the 40 eyes did the elevation progress.

CONCLUSIONS

A low-energy argon green laser application through a break in the inner layers of presumed retinoschisis eliminates the attenuation of the beam and can confirm retinoschisis.

Ultrasound biomicroscopy of the peripheral retina and the ciliary body in degenerative retinoschisis associated with pars plana cysts

AIM

To evaluate the ciliary body and peripheral retina in degenerative retinoschisis associated with pars plana cysts using ultrasound biomicroscopy (UBM).

METHODS

18 eyes of 12 patients with degenerative retinoschisis associated with pars plana cysts were selected through binocular indirect ophthalmoscopy and Goldmann three mirror lens examination, both with scleral depression. These patients were studied in detail with UBM.

RESULTS

Study of the ciliary body with UBM showed pars plana cysts of different size and uneven shape. In cross sections the morphology of pars plana cysts in detail and the close relation of the cysts with the oral region and the peripheral retina, where areas of cystoid degeneration and retinoschisis were present, were observed. In transverse sections three main morphological aspects of pars plana cysts could be differentiated ("isolated," "confluent," and "clustered" cysts). Furthermore, ultrabiomicroscopy allowed differential diagnosis between retinoschisis and associated retinal detachment in six eyes.

CONCLUSIONS

The study of peripheral degenerative retinoschisis and pars plana cysts is possible in vivo by means of UBM, showing the detailed morphology of the lesions (not otherwise evident through ophthalmoscopic examination) and the close relation between pars plana cysts, cystoid degeneration, and peripheral retinoschisis.

Degenerative retinoschisis threatening central vision

A 65-year-old white male patient presented with asymptomatic bilateral degenerative retinoschises. The striking feature of this case was the posterior extent of the retinoschises. In each eye the posterior margin of the retinoschisis lay within 15 degrees of the macula, thereby potentially endangering central vision. The posterior border of a retinoschisis often lies posterior to the equator. However, it seldom reaches the major retinal vascular arcades. It is even rarer for a retinoschisis to approach the macula.

Differentiation of degenerative retinoschisis from retinal detachment using optical coherence tomography

OBJECTIVE

To assess the potential of optical coherence tomography (OCT) to differentiate retinoschisis from retinal detachment. Optical coherence tomography is a noninvasive, noncontact imaging method that produces high-resolution, cross-sectional images of ocular tissue.

DESIGN

Retrospective case series.

PARTICIPANTS

Thirteen eyes of 12 patients with the differential diagnosis of retinoschisis versus retinal detachment.

METHODS

Differentiation between retinoschisis and retinal detachment was established from both ophthalmoscopic and OCT examinations.

MAIN OUTCOME MEASURE

Ability of OCT to differentiate retinoschisis from retinal detachment was measured.

RESULTS

Thirteen eyes of 12 patients with retinal elevation were examined with OCT. The cross-sectional view produced by OCT was effective in distinguishing retinoschisis from retinal detachment. Optical coherence tomography images of retinoschisis show a splitting of the neurosensory retina. The OCT images of retinal detachment show separation of full-thickness neurosensory retina from the retinal pigment epithelium band. The OCT images correlated with the clinical impression in all 13 cases.

CONCLUSIONS

Based on this series of cases, OCT is a potentially useful new test that may be used to distinguish retinoschisis from rhegmatogenous retinal detachment.