Repair of progressive retinal detachment complicating degenerative retinoschisis: surgical management and outcomes in phakic eyes

J Fernando Arévalo ,Sally S Ong,Alex Pham,James T Handa,Ishrat Ahmed

doi:10.1186/s40942-021-00344-2

Abstract

BackgroundDegenerative retinoschisis is a common condition defined by the splitting of the neurosensory retina that may rarely be associated with progressive retinal detachment (RD). Here, we aim to describe the anatomic and functional outcomes of surgical treatment of progressive symptomatic retinal detachment complicating degenerative retinoschisis (PSRDCR) using pars plana vitrectomy (PPV), scleral buckle (SB), or combined PPV/SB procedure.MethodsA retrospective chart review of patients with PSRDCR between Jan 1, 2008 and Dec 31, 2019 was conducted. Data regarding demographics, surgical approach, and anatomic/functional outcomes were collected.ResultsOf the 4973 charts with RD repair during the study period, 36 eyes (0.7%) had retinoschisis with RD. 18 eyes met inclusion criteria (0.4%). The median age was 54 years (range 18–74) and all eyes were phakic. All eyes had outer layer breaks (OLBs) and 16 eyes (89%) had identifiable inner layer breaks. All OLBs were posterior to the equator in charts where position was recorded (16 eyes). The single surgery anatomic success (SSAS) and final anatomical success rates were 66% (12/18) and 100%, respectively. Eyes treated with PPV/SB had an SSAS rate of 75% (9/12), while PPV and SB had SSAS rates of 66% (2/3) and 33% (1/3), respectively.ConclusionsPSRDCR is an exceedingly rare complication of degenerative retinoschisis associated with an SSAS rate lower than for uncomplicated rhegmatogenous RD. The majority of PSRDCR were repaired via combined PPV/SB in our study, and the rarity of this complication limits statistical support of an optimal surgical method in our and prior studies. The role of SB combined with PPV for PSRDCR requires further investigation.

Highlights

Degenerative retinoschisis, a cystic degeneration and splitting of the neurosensory retina in the outer plexiform layer, is common and estimated to affect approximately 4% of individuals aged 60–80 years [1]
With an incidence of 0.05% in patients with retinoschisis, an RD can progress beyond the borders of the schisis cavity with associated symptoms, which is designated as a progressive, symptomatic retinal detachment complicating retinoschisis (PSRDCR) [4]
Patient demographics and baseline characteristics Of the 4973 charts reviewed with retinal detachment, 36 had retinoschisis with RD (0.7%)

Summary

Introduction

Degenerative (senile) retinoschisis, a cystic degeneration and splitting of the neurosensory retina in the outer plexiform layer, is common and estimated to affect approximately 4% of individuals aged 60–80 years [1]. Retinal detachment (RD) within the zone of schisis, which is most frequently located in the inferotemporal quadrant, is one complication of retinoschisis [3, 4] These detachments develop due to the formation of an outer layer break (OLB) in the retina, allowing the fluid in the schisis cavity to enter the subretinal space [4]. With an incidence of 0.05% in patients with retinoschisis, an RD can progress beyond the borders of the schisis cavity with associated symptoms, which is designated as a progressive, symptomatic retinal detachment complicating retinoschisis (PSRDCR) [4] These detachments are commonly associated with both OLBs and inner layer breaks (ILB), thereby allowing vitreous to enter the schisis cavity and subsequently the subretinal space [4]. We aim to describe the anatomic and functional outcomes of surgical treatment of progressive symptomatic retinal detachment complicating degenerative retinoschisis (PSRDCR) using pars plana vitrectomy (PPV), scleral buckle (SB), or combined PPV/SB procedure

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