Macular retinoschisis associated with glaucomatous optic neuropathy in eyes with normal intraocular pressure.

Abstract

The purpose of this study was to evaluate the clinical features, optical coherence tomography (OCT) findings, and surgical outcomes of eyes with macular retinoschisis associated with glaucomatous optic neuropathy and normal intraocular pressure (IOP). In this retrospective interventional observational study, 11 eyes of 11 patients who underwent pars plana vitrectomy for macular retinoschisis and glaucomatous optic neuropathy were studied. All eyes had a vertical cup-to-disc ratio of ≥ 0.7 and retinal nerve fiber layer (RNFL) defects. Intraocular pressure (IOP) was <21 mmHg in all eyes, and there was no presence of congenital optic disc pits or high myopia in any eyes. The best-corrected visual acuity (BCVA) and the appearance of the fundus and OCT images were evaluated. The retinoschisis extended from the optic disc to the macula in all 11 eyes, and foveal detachment was present in 10 eyes. OCT showed vitreous adhesions near the RNFL defects and over the retinal vessels. The retinoschisis in the RNFL resolved immediately after the vitrectomy, and the BCVA improved significantly (p = 0.004). Macular retinoschisis resolved or decreased in all cases, although it required an average of 11 ± 3 months. The optic disc cup and RNFL defects were more clearly visible after resolution of the retinoschisis. Macular retinoschisis can develop from vitreous traction near the RNFL defect in eyes with glaucomatous optic neuropathy and normal IOP. We suggest that the traction on the structurally fragile RNFL contributed to the retinoschisis.