Author: Tomoka Ishida (Japan)
Co-authors: Makoto Inoue, Yoshiyuki Kita, Takashi Koto, Akito Hirakata
Purpose
Recently, the cases with papillomacular retinoschisis (PRS) from glaucomatous optic disc have been reported. The clinical findings and the prognosis of it are various; the retinoschisis is varied from only outer range to all layers including macular retinal detachment and the visual prognosis is varied from spontaneous resolution to worsens needed vitreous surgery. The mechanism of this condition is still unknown. The purpose of this study is to describe characteristics of the findings of fluorescein angiography (FA) and optical coherence tomography (OCT) in eyes with PRS from the glaucomatous optic disc.
Setting/Venue
Retrospective observational case series study in single center.
Methods
The subjects were the patients with PRS from glaucomatous optic disc who came to our Eye Center from Dec. 2009 to Aug. 2019 and were followed up over one year. We excluded the eyes without FA data, high myopic eyes (refractive error<-8.0 diopters or axial length>26.5mm), eyes with congenital optic disc pit and the glaucomatous eyes with only serous retinal detachment. Finally, 16 glaucomatous eyes with PRS were enrolled. We reviewed the findings of FA and categorized PRS into two groups based on whether hyper fluorescence staining at the optic disc was observed (group 1, n=9) or not (group 2, n=7), and compared the characteristics of OCT findings between both groups.
Results
In group 1, the hyper fluorescence staining began between 26 seconds to 45 seconds after injection of fluorescein. One eye showed it starting from center of the optic disc to spread to rim near the retinoschisis, but other 8 eyes showed it starting from the rim near the retinoschisis. This FA finding was corresponded to nerve fiber schisis on optic disc on laminar cribrosa (LC) but the hyper fluorescence was not spread to retinoschisis. There was no significant difference about average age, baseline best-corrected visual acuity, baseline intraocular pressure, refractive error, axial length, baseline mean deviation value, sex distribution, max central retinal thickness at the fovea, choroidal thickness under the fovea and the distribution of retinoschisis between these two groups. On OCT, the rates of exitance of gamma zone, nerve fiber edema on LC and downward slope of optic disc were significantly higher in group 1 than in group 2 (P=0.00481, P=0.0230, P=0.0350). There was no significant difference of the exitance of beta zone and LC defect on temporal area of optic disc between both group (P=1.000, P=0.0796).
Conlusions
The FA finding could be classified into two patterns; with hyper fluorescence on the optic disc or without it. In group 1, the nerve fiber schisis on the optic disc showed tissue staining on FA and the cause of it would have some relationship with the deformation and distortion of glaucomatous optic discs. On the other hands, the retinoschisis in both groups was not hyper fluorescent, and it would be caused by flow of vitreous fluid because the fluid is not influenced by fluorescein.
Financial Disclosure
non
Comments
-
