From the Guidelines
Retinal detachment (retinoshisis) or retinoschisis is a rare eye condition characterized by the splitting of the retina's layers, typically occurring between the nerve fiber layer and the ganglion cell layer, often associated with vitreomacular traction and epiretinal membranes. The condition can lead to decreased visual acuity, peripheral vision loss, and in some cases, strabismus (crossed eyes) 1. There are two main types: X-linked juvenile retinoschisis, which is genetic and affects primarily males, and acquired retinoschisis, which typically develops in older adults. Symptoms may include decreased visual acuity, peripheral vision loss, and in some cases, strabismus (crossed eyes). Many patients with mild retinoschisis require no treatment as the condition often remains stable. For more severe cases, management focuses on treating complications like retinal detachment or vitreous hemorrhage. Regular eye examinations are essential for monitoring the condition, with frequency determined by severity. Low vision aids may help those with significant visual impairment. The condition occurs due to abnormalities in the retinoschisin protein in the genetic form, while the acquired form may result from age-related vitreous changes causing traction on the retina, as seen in vitreomacular traction where the perimacular vitreous continues to separate from the posterior retina yet remains adherent to a region or area near the center of the macula 1. Some key points to consider in the management of retinoschisis include:
- The importance of early detection through comprehensive eye exams to manage potential complications and preserve vision
- The role of vitreomacular traction and epiretinal membranes in the development of retinoschisis
- The need for regular monitoring and potential treatment of complications like retinal detachment or vitreous hemorrhage
- The use of low vision aids to help those with significant visual impairment. As noted in the study by 1, the combination of attachment at the macula with surrounding vitreous separation creates traction and may lead to thickening, distortion, intraretinal cystoid changes and even subretinal fluid or tractional detachment at the macula.
From the Research
Definition of Retinal Detachment (Retinoshisis) or Retinoschisis
- Retinal detachment (retinoshisis) or retinoschisis is a condition characterized by the elevation of the inner layers of the peripheral retina, which can lead to retinal detachment associated with isolated outer layer breaks (termed schisis-detachment) 2.
- Degenerative retinoschisis is a common condition that is almost invariably a benign process, but retinal detachment associated with outer layer breaks can be a vision-threatening condition that requires intervention 2.
Clinical Features and Diagnosis
- Outer layer breaks (OLBs) are considered forerunners of symptomatic complications in asymptomatic degenerative retinoschisis, and prophylactic photocoagulation may be a better choice than mere observation in selected cases 3.
- Clinical examination remains the mainstay of diagnosis, but recent advances in multimodal imaging can provide supplemental information in subtle cases and may prove valuable for long-term disease monitoring 2.
Surgical Management
- Surgical management of retinoschisis-related retinal detachment (RSRD) poses challenges, and final retinal attachment can be achieved successfully but often requires secondary and staged surgeries 4.
- Different surgical techniques, such as scleral buckling, vitrectomy, and combined scleral buckling and vitrectomy, have been used to treat retinal detachment associated with degenerative retinoschisis, with varying degrees of success 4, 5, 6.
- The choice of surgical technique depends on the location and extent of the outer layer breaks, as well as the presence of other complications, such as proliferative vitreoretinopathy 5, 6.