However, detachments are still very rare (occur in 0.05% of patients with retinoschisis). It's important to note that the patient may be asymptomatic due to the absolute scotoma in senile retinoschisis, even in the presence of an RRD. However, they may be spontaneous and are often small and not easily visualized. These inner wall breaks may occur from acute PVD and vitreous traction. Progressive RRD results from breaks in both inner and outer layer of breaks, allowing liquified vitreous to enter the subretinal space. Progressive rhegmatogenous retinal detachment Additionally, while rare, potential side effects of retinopexy include intraocular inflammation, retinal breaks, and epiretinal membrane formation. One must note that although patients may be asymptomatic at the time of intervention, the decision to intervene often is due to the more posterior extent of the detachment, and retinopexy to the posterior border may introduce scotomata that may be now symptomatic for the patient. Also, scatter photocoagulation to the entire bed of the schisis cavity has been noted to aid collapse of the cavity. Laser demarcation or cryotherapy when posterior margin is anterior enough has been demonstrated effective at preventing progression in the majority of patients.
Retinal detachment optomap series#
Most series note that approximately half of RS with outer wall breaks will remain stable, and half will progress to schisis detachment. In addition, subretinal fluid (SRF) typically doesn't extend past the walls of schisis (viscous intraschisis fluid with mucopolysaccharides transmits slowly). A ring of pigmentation at the border of the detachment indicates chronicity. Schisis detachments may develop in a small (3 disc diameters (DD), round, and posterior, with rolled edges. Outer wall breaks have a 10-27% incidence and usually can be observed. Outer wall breaks and "schisis detachment" Neither cataract surgery nor PVD have any adverse effect on retinoschisis because pathology is within the retina and not at the vitreoretinal interface. Additionally, no treatment, including laser, has been shown to halt the progression of retinoschisis.Īlthough approximately three-quarters of lesions will have their most posterior extent postequatorial, only about three percent will progress posteriorly, so most still can be observed. The natural history is that this disease rarely progresses from where it's first observed, so resist lasering: most cases of posterior retinoschisis will not progress beyond 3 disc diameters from the macula and only a handful of cases of degenerative retinoschisis involving the macula have been reported. Senile retinoschisis is usually benign but complications include: May be difficult to distinguish from longstanding retinal detachment (RD): A smooth or bullous elevation is also seen in retinal detachments, but characteristics for a longer standing retinal detachment are RPE alterations and demarcation lines.OCT shows a break in the outer plexiform layer (OPL) in retinoschisis and not detachment of retina from RPE.Retinoschisis will not re-appose with scleral depression (no subretinal fluid to move out).Laser will blanch retinoschisis but not a rhegmatogenous retinal detachment (RRD).Check for an absolute scotoma with indirect ophthalmoscope perimetry: hold a scleral depressor on the observer's side of the condensing lens and document whether patient can see the depressor's shadow.Splitting at outer plexiform layer in senile retinoschisis Diagnostic procedures Associated with peripheral microcystoid degeneration.a relative scotoma in a retinal detachment). There will be no retinal tears, vitreous pigment cells, or demarcation lines unlike in a retinal detachment (RD).The inferotemporal location is most common.The vessels appear darker over the affected area. There can be an inner layer "beaten metal" or pitted appearance with minute glistening yellow-white surface dots, with minimal retinal pigment epithelium (RPE) alterations or atrophy.
It will be dome shaped with uniform convexity and without corrugations often seen in a rhegmatogenous retinal detachment (RRD).
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