Purchase this article with an account.
Hilary Brader, Brian VanderBeek, Albert Maguire, Jason Ruggiero, Paul Tapino, Alexander Brucker, Tomas Aleman; Retinal Lamination Patterns in Macular Retinoschisis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1366.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To describe and quantify the changes in lamination patterns in different forms of macular schisis.
Subjects (n=28) with clinically apparent macular retinoschisis associated with X-linked retinoschisis (XLRS), optic pit, optic nerve defect without pit, vitreomacular traction (VMT) and myopic traction maculopathy (MTM) were imaged with optical coherence tomography (OCT). Overall retinal thickness, outer nuclear layer (ONL) and inner retinal thickness (from the outer plexiform layer to the vitreoretinal interface) were measured along the horizontal and vertical meridians. The change in thickness for each lamina relative to normal values, plotted against each other, was used to probe for specific patterns of schisis.
All patients with XLRS (7/7) showed a thickened inner retina when compared to normal controls; their ONL was normal or slightly thinned in 5 subjects (71%) and was only modestly thickened in 2 subjects. In contrast, all subjects with an optic nerve defect with or without an optic pit (7/7), were found to have a significantly thickened ONL and near-normal (5/7) inner retinal thickness. Patients with schisis associated with VMT and MTM showed splitting in both the inner and the outer retina (13/14); only one subject in this category had a thickened ONL but nearly normal inner retinal thickness.
Abnormal lamination in macular retinoschisis follows three main patterns: (a) predominantly inner retinal splitting in XLRS; (b) predominantly outer retinal splitting with relative preservation of the inner retina in schisis associated with optic nerve structural abnormalities; and (c) involvement of the entire retina in VMT and myopia. These three distinct patterns of retinoschisis correspond to the current understanding of the underlying pathophysiologic mechanisms of retinal splitting in each of these three disease processes, specifically: (a) nonadhesion of retinal layers in XLRS; (b) a presumed mechanical dissection of the retina by fluid through a defect or conduit in the peripapillary retina in schisis associated with optic nerve abnormalities; and (c) traction on the retina originating from structures internal to the optic nerve fiber layer (internal limiting membrane, epiretinal membrane, posterior hyaloid, etc.) in VMT and MTM. These observable patterns of schisis suggest distinct underlying pathophysiological mechanisms and may aid in the differential diagnosis of macular retinoschisis.
This PDF is available to Subscribers Only