Spontaneous resolution of peripapillary retinoschisis associated with glaucomatous optic neuropathy

Optic disc pits are congenital anomalies of the optic nerve head and are commonly associated with retinoschisis and serous retinal detachment. Macular or peripapillary retinoschisis can develop after an acute increase of intraocular pressure (IOP) in eyes with enlarged optic disc cups but without congenital optic disc pits (Hollander et al. 2005; Kahook et al. 2007). We report an eye with peripapillary retinoschisis associated with glaucomatous optic neuropathy and normal IOP. A 53-year-old woman visited a local clinic for visual field defect in her right eye associated with headaches and periorbital pain. She was referred to our clinic on September 2008. She was diagnosed with borderline glaucoma earlier. Her visual acuity was 20/20 in both eyes, and the refractive error was –1.0 D OD and –0.25 D OS. Her IOP was 14 mmHg OD and 15 mmHg OS. Ophthalmoscopy revealed bilateral neuroretinal rim narrowing at the optic disc margin, inferior retinal nerve fibre layer (RNFL) defect and peripapillary retinoschisis without a posterior vitreous detachment in the right eye with normal open anterior chamber angle (Fig. 1). Fluorescein angiography showed no leakage or any signs of an optic disc pit. Optical coherence tomography (OCT, OCT3-STRATUS, Carl Zeiss Meditec) revealed peripapillary retinoschisis and retinal detachment. Humphrey field analyzer (Humphrey- Zeiss System) showed a superior Bjerrum scotoma corresponding to the inferior RNFL defect in both eyes. She was followed without any treatment because of her good vision. The headaches and periorbital pain disappeared after 1 month. She noticed that the paracentral scotoma had moved gradually towards the central visual field, and the peripapillary retinoschisis turned to macular retinoschisis at 15 months but she maintained good vision of 20/20. The macular retinoschisis completely resolved after 3 years without any recurrence for 2 years. Vision was maintained at 20/20 without a central scotoma. The IOP remained within the normal range without any topical medication and no progression of the visual field defect was detected. Spectral domain OCT (Cirrus-HD-OCT, Carl Zeiss Meditec) showed a resolution of the macular retinoschisis with partially detachment of the posterior vitreous cortex. The optic disc cup was deeper corresponding to the resolution of the peripapillary retinoschisis and schisis within the optic disc. Kahook et al. (2007) described two cases of peripapillary retinoschisis associated with increased IOP and angle-closure glaucoma. An acute elevation of the IOP can lead to structural defects in the optic nerve head and peripapillary retinoschisis as seen in cases of optic disc pit maculopathy. Zumbro et al. (2007) reported that vitreous surgery can resolve a retinoschisis associated with an enlarged optic disc cup. They reported that vitreous traction may have played a role in the development of the macular retinoschisis and foveal detachment. Zhao & Li (2011) described a case of macular retinoschisis that developed in an eye with normal tension glaucoma. They also suggested that vitreous traction was the cause of the retinoschisis near the RNFL defect, and the foveal detachment developed by the seeping of fluid through the intraretinal spaces. The IOP was normal as in our patient, and vitreous traction probably caused the peripapillary and macular retinoschisis that resolved spontaneously when the posterior vitreous cortex was partially detached. Hwang et al. (2014) described a case of peripapillary retinoschisis within the retinal nerve fibre, ganglion cell and inner plexiform layers detected in the OCT images of 19 glaucomatous eyes. However, none of the eyes developed macular retinoschisis, and the peripapillary retinoschisis resolved without any treatment. Our patient developed symptomatic peripapillary retinoschisis and retinal detachment which expanded to macular retinoschisis. Thus, peripapillary retinoschisis associated with glaucomatous optic neuropathy can progress to macular retinoschisis which can resolve spontaneously by a partial vitreous detachment.