A Comparison of Imaging Modalities in the Diagnosis and Management of Retinoschisis

Abstract

Abstract: : Purpose: To investigate the various imaging modalities used in the diagnosis and management of retinoschisis, and to determine the advantages and disadvantages of each. Methods: A series of cases encompassing all three types of retinoschisis (juvenile, degenerative and secondary) were reviewed retrospectively. Each case had undergone multiple imaging procedures including color fundus photography, fluorescein angiography (FA), optical coherence tomography (OCT), B–scan ultrasonography, ultrasound biomicroscopy (UBM), and scanning laser ophthalmoscope microperimetry (SLO). Results: In the case of retinoschisis affecting the posterior pole, color fundus photography is a useful tool for recording a baseline image and to track the progression or regression of the disease. However, in juvenile X–linked retinoschisis, the foveal cysts present in the macula are not usually captured in a color photograph. FA is able to differentiate the foveal cysts associated with retinoschisis from other cystic macular processes since no pathologic fluorescence is seen with retinoschisis. OCT can reveal cystic spaces within the retinal layers and is very useful for confirming the presence of retinoschisis in cases that pose a diagnostic challenge due to a generally flat appearing retina. OCT is also a very useful imaging modality in children as compared to other techniques due to its non–invasive and non–contact approach. B–scan ultrasonography is helpful in the diagnosis and follow–up of peripheral shallow or bullous retinoschisis, and to differentiate it from retinal detachment. UBM is useful in the assessment of the anterior retina, revealing the presence of anterior retinoschisis. SLO microperimetry can differentiate retinal detachment from retinoschisis in cases that are difficult to assess clinically by revealing relative scotoma in an area of retinal detachment and an absolute scotoma in an area of schisis. Conclusions: Retinoschisis is a type of retinal degeneration categorized by splitting of neurosensory retinal layers. Modern imaging modalities are exceptionally useful in multiple aspects of retinoschisis management, especially in diagnosing the disease, differentiating between its various etiologies, and following the condition long term. OCT may be the best imaging procedure for the disease affecting the posterior pole since it clearly elucidates the pathology: cystoid spaces in the nerve fiber layer in juvenile X–linked retinoschisis, versus a splitting of the outer nuclear layer in age–related retinoschisis.

Keywords: retinal degenerations: hereditary • imaging/image analysis: clinical • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)