Optical coherence tomography of a peripheral retinal schisis with an outer retinal layer break

A 63-year-old-woman reported experiencing photopsias in her left eye. Visual acuity measured 20/20. Slit-lamp biomicroscopy of the anterior segment and the central fundus was unremarkable. Ophthalmoscopic examination suggested a peripheral retinoschisis with a break in the outer retinal layer (Fig. 1). An optical coherence tomography (OCT) examination (OCT 3, software release A1.1; Zeiss-Humphrey Ophthalmic Systems, Dublin, California, USA) was performed to confirm the diagnosis. Imaging of the lesion located in the temporal inferior periphery of the fundus was achieved by positioning the external fixation light attached to the OCT operator as far as possible towards the 5 o'clock position. A scanning line (5 mm in length) was positioned onto the border of the suspected outer retinal break in the region of the retinal schisis (Fig. 2). Optical coherence tomography images verified both the retinoschisis and the outer retinal break (2, 3). Fundus photograph showing a retinal schisis with an outer layer retinal break in the periphery of the temporal inferior quadrant (arrows). Red bars indicate the imaging lines of the OCT operator. OCT image of the retinoschisis, showing a detached inner retinal layer (arrows). The outer retinal layer is partially attached to (arrowhead) and partially detached from (asterisks) the retinal pigment epithelium. OCT image of the retinoschisis, showing the edge of the break in the outer retinal layer (arrow). The inner retinal layer is detached (asterisks). Optical coherence tomography (Huang et al. 1991; Hee et al. 1995a) has increasingly been used for imaging of the posterior pole of the eye for the diagnosis of various diseases such as macular oedema, epimacular membranes, exudative age-related macular degeneration and glaucoma (Huang et al. 1991; Hee et al. 1995b; Puliafito et al. 1995; Medeiros et al. 2003). The present clinical report demonstrates the use of OCT in imaging abnormal findings in the fundus periphery. Furthermore, OCT can also improve standard diagnostic procedures for other diseases located in the fundus periphery, by, for example, identifying pseudo holes in retinovitreal proliferations (Kamppeter & Jonas 2003). It can also be used to differentiate between peripheral choroidal nevi and melanomas by looking for a shallow collateral retinal detachment as a sign of malignancy, and to distinguish between a retinoschisis and a rhegmatogenous retinal detachment by measuring retinal thickness and looking for the photoreceptor layer that lies attached to Bruch's membrane.