Abstract
Purpose:
Retinoschisis is a well-recognized complication of pars planitis, yet little data is available regarding its prevalence and course. The purpose of this study is to determine the incidence, presentation, and course of retinoschisis in patients with pars planitis.
Methods:
Retrospective chart review was performed on all patients with pars planitis meeting Standardization of Uveitis Nomenclature disease definition seen by the Uveitis service of one of the authors from July 2012 - September 2014.
Results:
34 patients (68 eyes) who met disease definition were included. 21 patients were female (62%). The majority of patients were Caucasian (n=23, 68%); the remainder were Hispanic (n=10, 29%) and Asian (n=1, 3%). 13 eyes (19%) developed retinoschisis. In all cases, schisis was inferiorly located, posterior to the snowbank. In 6 patients (86%) the schisis was bilateral. 4 patients with schisis were Caucasian (57%), 2 were Hispanic (29%) and 1 was Asian (14%). 4 patients were female (57%). Average follow-up of patients with schisis was 7 years (3.7 - 9.6 years); average visual acuity of eyes with schisis was 20/22 at last follow-up. 5 eyes of 5 patients underwent pars plana vitrectomy. 3 had vitrectomy for disease control with scleral buckle placement to reduce residual traction. In one eye, the schisis did not progress despite active vitreous inflammation, while the other developed schisis while inflammation was uncontrolled. The third was only noted to have schisis at the time of vitrectomy. Two eyes of two patients required pars plana vitrectomy for retinal detachment with progressive schisis despite control of uveitis. Silicone oil was used in these cases. 8 eyes with retinoschisis remained stable without need for surgical intervention.
Conclusions:
Retinoschisis is a common complication in patients with pars planitis at a tertiary referral practice. It is typically bilateral, inferior, and may develop in eyes with both controlled and uncontrolled disease. Even in eyes that require surgical management of progressive schisis, visual outcome can be favorable. While inflammatory mediators may play a role in development and progression of schisis, the presence of inflammation may not correlate with progression of schisis. In all cases schisis was adjacent to a snowbank, suggesting that mechanical forces may lead to development of schisis and retinal detachment even in patients with inactive disease.