Atlas of Ophthalmology

Peripapillary Retinoschisis with Two Isolated Cavities in POAG (Colour, Visual Field, OCT)

Glaucomas
We report a case of two isolated peripapillary retinoschisis cavities in two different retinal layers. There is evidence of retinoschisis with involvement of several retinal layers without detectable evidence of an optic nerve pit. A 67-year-old woman with a nine-year history of glaucoma presented with IOPs of 21 right eye (OD) and 21 left eye (OS) and open angles. Manifest refraction was +0.75 diopters OD and +0.25 diopters OS. The colour image showed a focal nerve fiber defect at 4h. OCT revealed two isolated peripapillary retinoschisis cavities at two retinal levels with no apparent vitreous detachment or optic nerve pit. The retinoschis cavities were in the area of the focal nerve fiber loss inferotemporal. Spectral optical coherence tomography (Spectralis OCT, HE, Heidelberg, Germany) showed 2 schisis cavities in different levels of the retina: cavity #1 between the hyperreflective outer plexiform layer (OPL) and the hyporeflective outer nuclear layer (ONL),and cavity #2 within the hyperreflective retinal nerve fiber layer (NFL). Visual field testing showed a tiny superior scotoma. The cause of peripapillary retinoschisis cavities is unclear (1). It may represent a unique sequelae of intraocular fluctuations in patients with glaucoma. Literature: (1) Kahook MY, Noecker RJ, Ishikawa H, Wollstein G, Kagemann L, Wojtkowski M, Duker JS, Srinivasan VJ, Fujimoto JG, Schuman JS. Peripapillary schisis in glaucoma patients with narrow angles and increased intraocular pressure. Am J Ophthalmol. 2007 Apr;143(4):697-9.

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