Hawaii Macula and Retina Institute, Aiea, Hawaii.
Hawaii Macula and Retina Institute, Aiea, Hawaii; University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii.
Ophthalmol Retina. 2023 Sep;7(9):811-818. doi: 10.1016/j.oret.2023.05.020. Epub 2023 Jun 2.
To review eyes with peripapillary and macular retinoschisis without a visible optic pit or advanced glaucomatous optic atrophy, or No Optic Pit Retinoschisis (NOPIR).
Retrospective multicenter case series.
The study included 11 eyes of 11 patients.
Retrospective study of eyes with macular retinoschisis without a visible optic pit, advanced optic nerve head cupping, or macular leakage on fluorescein angiography.
Visual acuity (VA), retinoschisis resolution, months to resolution, and recurrence of retinoschisis RESULTS: The mean age was 68.1 ± 17.6 years, mean intraocular pressure was 17.4 ± 3.8 mmHg, and the mean spherical equivalent refractive error was -3.1 ± 2.9 diopters. No subject had pathologic myopia. Seven subjects were treated for glaucoma, and 9 subjects had nerve fiber layer defects on OCT. All eyes had retinoschisis in the outer nuclear layer (ONL) in the nasal macula and extending to the edge of the optic disc, and 8 subjects had fovea-involving retinoschisis. Three nonfoveal and 4 fovea-involved eyes were observed, and 4 fovea-involved eyes with vision loss underwent surgery. Surgery involved preoperative juxtapapillary laser followed by vitrectomy and membrane and internal limiting membrane peeling with intraocular gas and face-down position. The mean baseline VA was significantly worse in the surgery group than that in the observation group (P = 0.020). Retinoschisis resolved and vision improved in all surgical cases. The mean resolution time for the surgery group was 2.75 ± 0.96 months, which was shorter than that for the observation group (28.0 ± 21.2 months; P = 0.014). No eye developed recurrence of the retinoschisis after surgery.
Peripapillary and macular retinoschisis can develop in eyes without a visible optic pit or advanced glaucomatous cupping. Eyes without foveal involvement and those with foveal involvement but only mild decrease in vision can be observed for spontaneous resolution. If there is persistent foveal involvement with vision loss, surgery can improve vision by resolving the macular retinoschisis. Surgery for fovea-involved macular retinoschisis without a visible optic pit resulted in faster anatomic resolution and better vision recovery.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
回顾无可见视盘小凹或晚期青光眼性视神经萎缩的周边部和黄斑部视网膜劈裂，或无可见视盘小凹的视网膜劈裂（NOPIR）。
回顾性多中心病例系列。
该研究纳入了 11 名 11 只眼的患者。
对黄斑部视网膜劈裂但无可见视盘小凹、晚期视乳头杯状或黄斑部荧光素血管造影渗漏的眼进行回顾性研究。
视力（VA）、视网膜劈裂复位、复位时间和视网膜劈裂复发情况。
平均年龄为 68.1±17.6 岁，平均眼内压为 17.4±3.8mmHg，平均等效球镜屈光度为-3.1±2.9 屈光度。无病理性近视患者。7 例患者接受青光眼治疗，9 例患者 OCT 检查有神经纤维层缺损。所有眼的外核层（ONL）均有鼻侧黄斑部视网膜劈裂，延伸至视盘边缘，8 例患者有累及黄斑的视网膜劈裂。3 例非黄斑区受累和 4 例黄斑区受累的眼进行了观察，4 例视力下降的黄斑区受累眼接受了手术治疗。手术包括术前视盘旁激光光凝，随后行玻璃体切割术，并进行内界膜和视网膜内界膜剥除，眼内填充气体并保持面朝下体位。手术组的基线视力明显差于观察组（P=0.020）。所有手术病例的视网膜劈裂均得到解决，视力提高。手术组的平均复位时间为 2.75±0.96 个月，短于观察组（28.0±21.2 个月；P=0.014）。手术后无眼出现视网膜劈裂复发。
无可见视盘小凹或晚期青光眼性杯状凹陷的眼可出现周边部和黄斑部视网膜劈裂。无黄斑区受累和仅有轻度视力下降的黄斑区受累眼可观察其自然复位。如果持续存在黄斑区受累伴视力下降，手术可通过解决黄斑部视网膜劈裂来提高视力。对于无可见视盘小凹的黄斑区受累视网膜劈裂，手术治疗可更快地实现解剖复位并获得更好的视力恢复。
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