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S. Nath, Sr., J. Sherman, D. Rutner, R. J. Madonna, S. Bass; OCT Study in High Myopes Reveals 360 Degree Peripapillary Retinoschisis as a Novel Explanation of Blindness. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4706.
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© ARVO (1962-2015); The Authors (2016-present)
To document spectral domain (SD) findings unique to high myopia that are responsible for vision reduction.
A retrospective analysis of 20 myopic eyes >10 D of 10 consecutive patients who were examined with SD OCT. A 6x6mm section was placed on the disc, macula, and any other area of interest. Each scan resulted in 128 horizontal cross sections that were analyzed. Comparisons were made to 50 normal eyes in 25 subjects with low refractive errors.
1 eye of 2 patients had CNVM on SD OCT and confirmed by FA. 1 eye also has microfolds associated with retinal vessels. Posterior staphyloma and zones of chorio-retinal attenuation were found with SD OCT on virtually every myopic eye. 1 eye had a retinoschisis in the macula responsible for VA loss. 2 eyes of the same patient demonstrated peripapillary retinoschisis (PPR) on SD OCT that did not include the macula. 1 of these eyes had a 360 PPR (w/o retinal or choroidal detachment) and BCVA of 1/800 with no other explanation for blindness. The schisis was not visible ophthalmoscopically or on B-scan. Frame by frame analysis demonstrated vitreal-retinal traction (VRT) in multiple zones as the cause of the schisis and obvious multiple splits at various layers within the retina. 8 of the 20 myopic eyes appeared to have a wide "gap" without obvious splits in the OCT images at the level of the outer nuclear layer. None of these SD OCT findings were found in the normal group.
PPR without macula schisis appears to be a new entity not previously reported but easily documented with SD OCT. Whether microfolds or a "gap" lead to PPR awaits further study. SD OCT may reveal findings invisible to ophthalmoscopy, B-scan, and time domain OCT. Early detection of findings such as VRT in retinoschisis may lead to timely intervention.
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