Management of Degenerative Retinoschisis–Associated Retinal Detachment

Abstract

To review a population of degenerative retinoschisis (RS) patients, with attention to those with schisis cavity breaks and with retinal detachment complicating retinoschisis (RDRS), to identify management considerations and incidence for this rare clinical entity. Retrospective chart review of patients with RS and schisis cavity breaks over a 15-year period in a tertiary, multiple-physician vitreoretinal practice. A total of 587 cases of RS were confirmed on chart review, with 59 meeting inclusion criteria. Included charts required documented RS with schisis cavity breaks, a minimum of 3 months of follow-up, detailed fundus drawings and notes, and filed operative report if surgical interventions were performed. Charts were excluded if the patient had undergone any previous history of laser, cryotherapy, or intraocular surgery (except for cataract surgery). Incidence of RS with schisis cavity breaks and RDRS, time to development of symptomatic RDRS, clinical characteristics predisposing development of progressive RDRS. Sixty-seven cases (11.4%) presented with schisis cavity breaks, but only 59 met inclusion. Initially, 35 of the 59 included cases (59%) were observed with stability in 54.3% at a mean follow-up of 40.2 months. Only 10 of the initially observed 35 eyes (28.6%) exhibited new-onset symptoms of retinal detachment, with a mean time to progression of 20.6 months. Posterior progression involving the major arcades or macula occurred in 86.7% of symptomatic eyes, as compared with 11.4% of asymptomatic eyes (P < 0.0001). Of the 15 eyes with symptomatic RDRS, 14 eyes underwent vitreoretinal surgery for RDRS, with a single-procedure success rate of 86%. RDRS requiring vitreoretinal surgical repair is a rare, symptomatic, and progressive condition occurring in 2.4% of 587 cases of RS over a 15-year period in a large, tertiary referral, vitreoretinal-only practice. In cases with RS and outer wall breaks, 54.3% were nonprogressive at 3 years of follow-up, but 28.6% progressed to symptomatic RDRS at a mean of 20.6 months. Surgery is not recommended in asymptomatic individuals except in rare situations based on clinical judgement regarding the observed behavior of the RS. The presence of symptoms should warrant treatment.