Rachitskaya Aleksandra V, Yuan Alex, Singh Rishi P, Sears Jonathan E, Schachat Andrew P
Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Br J Ophthalmol. 2017 Apr;101(4):445-448. doi: 10.1136/bjophthalmol-2016-308551. Epub 2016 Jun 24.
On clinical examination, it can be challenging to differentiate retinoschisis with outer retinal hole from schisis-detachment. This study examined the role of outer retinal hole spectral domain optical coherence tomography (SD-OCT) imaging in conjunction with imaging of the posterior schisis cavity edge in differentiating between these conditions.
This is a retrospective case series. Out of 500 subjects with ICD-9 diagnoses of senile retinoschisis (361.10, 361.11, 361.12, 361.19) from January 2004 to December 2014, 62 had evidence of retinoschisis on fundus photography or optical coherence tomography (OCT). Six eyes of five patients had outer retinal holes documented by fundus photography (Optos, Marlborough, Massachusetts, USA) and SD-OCT (Carl Zeiss Meditec, Dublin, California, USA). The OCT morphology of outer retinal holes, subjects' symptomology, visual acuity, fundus examination, diagnosis and progression of the disease were analysed.
All five patients were women; the mean age was 67.4 years. The correct diagnosis was recorded in the chart in 50% of cases. All, but one, were asymptomatic with visual acuity ranging from 20/20 to 20/200. Three types of outer retinal hole OCT morphology in conjunction with imaging of the posterior schisis cavity edge were established. (1) Outer retinal hole with both edges down and attached to retinal pigment epithelium (RPE) and the edge of the cavity showing a split in neurosensory retina corresponded to isolated retinoschisis. The outer retinal hole with (2) one or (3) both edges detached from the RPE and the edge of the cavity showing complete separation of retina from RPE corresponded to schisis-detachment. One patient underwent scleral buckle surgery for schisis-detachment. Otherwise, no treatment was performed and no progression was noted with the longest OCT-documented follow-up of 26 months.
The OCT morphology of outer retinal holes in conjunction with imaging of the posterior schisis cavity edge aids in the diagnosis of retinoschisis and schisis-detachment.
在临床检查中，区分伴有外层视网膜裂孔的视网膜劈裂与劈裂性视网膜脱离具有挑战性。本研究探讨了外层视网膜裂孔的光谱域光学相干断层扫描（SD-OCT）成像联合后部劈裂腔边缘成像在鉴别这两种情况中的作用。
这是一项回顾性病例系列研究。在2004年1月至2014年12月期间500例国际疾病分类第九版（ICD-9）诊断为老年性视网膜劈裂（361.10、361.11、361.12、361.19）的患者中，62例在眼底照相或光学相干断层扫描（OCT）检查中有视网膜劈裂的证据。5例患者的6只眼中，经眼底照相（美国马萨诸塞州马尔伯勒市Optos公司）和SD-OCT（美国加利福尼亚州都柏林市卡尔·蔡司医疗技术公司）记录有外层视网膜裂孔。分析了外层视网膜裂孔的OCT形态、患者症状、视力、眼底检查、疾病诊断及进展情况。
所有5例患者均为女性，平均年龄67.4岁。50%的病例在病历中有正确诊断记录。除1例患者外，其余均无症状，视力范围为20/20至20/200。结合后部劈裂腔边缘成像，确立了三种类型的外层视网膜裂孔OCT形态。（1）外层视网膜裂孔的两边向下并附着于视网膜色素上皮（RPE），腔隙边缘显示神经感觉视网膜劈裂，对应孤立性视网膜劈裂。外层视网膜裂孔（2）一边或（3）两边与RPE分离，腔隙边缘显示视网膜与RPE完全分离，对应劈裂性视网膜脱离。1例患者因劈裂性视网膜脱离接受了巩膜扣带术。否则，未进行治疗，在最长达26个月的OCT记录随访中未观察到病情进展。
外层视网膜裂孔的OCT形态联合后部劈裂腔边缘成像有助于视网膜劈裂和劈裂性视网膜脱离的诊断。
