case_images: PMC10894533_01
case_images: Ultra-wide field fundus photography at presentation demonstrating peripheral retinoschisis with vitreous veils in both eyes and inferotemporal rhegmatogenous retinal detachment in the left eye.
case_images: 10.1177_25158414241232261-fig1.jpg
case_images: PMC10894533_01_10.1177_25158414241232261-fig1.jpg
case_images: fig1-25158414241232261
case_images: Dilated fundus examination revealed a large peripheral retinal schisis cavity and vitreous veils as well as the typical spoke wheel pattern in the macula in OD and similar fundus findings as well as macula involving RRD in the inferotemporal retina (from 2 to 8 clock hours) in the presence of two adjacent retinal breaks in the 4th clock hour in OS (Figure 1).
case_images: (a) SD-OCT of right eye illustrating foveal and lamellar macular schisis at the level of the outer plexiform layer. (b) Preoperative SD-OCT of the left eye showing macular retinoschisis and retinal detachment with macular involvement. (c) SD-OCT on the first postoperative day demonstrating significant resolution of macular schisis and retinal thinning due to collapse of schistic cavities in the left eye. The anterior most hyperreflective layer corresponds to silicone oil.. SD-OCT, spectral domain optical coherence tomography.
case_images: 10.1177_25158414241232261-fig2.jpg
case_images: PMC10894533_01_10.1177_25158414241232261-fig2.jpg
case_images: fig2-25158414241232261
case_images: Spectral domain optical coherence tomography (SD-OCT) demonstrated schistic macular edema in both eyes with large schistic cavities extending from the inner plexiform (IPL) to the outer plexiform layers (OPL) [Figure 2(a) and (b)]. Detachment of the temporal half of the macula was also evident in SD-OCT in OS [Figure 2(b)]. SD-OCT showed significant resolution of the foveal and macular schisis [Figure 2(c)].
case_images: (a, b) OCTA of the left eye 1 week post-operatively capturing abnormalities of the foveal avascular zone (a) at the level of the SCP and (b) DCP and loss of focal loss of DCP density in the left eye. (c) SD-OCT showing macular thinning temporally with collapse of the schistic cavities noted earlier and presence of residual intraretinal cysts nasally. (d, e) OCTA 1 month postoperatively revealed areas of flow loss (d) in the DCP also evident (e) in the CCP. (f) SD-OCT after 1 month showed subtle reappearance of the schistic spaces throughout the entire macula. (g, h) Enlargement of previously observed flow void areas in OCTA (g) in the DCP as well as (h) the CCP at the 3 months follow-up. (i) SD-OCT at 3 months demonstrated deterioration of macular schisis with loss of foveal contour.. CCP, choriocapillaris; DCP, deep capillary plexus; OCTA, optical coherence tomography angiography; SCP, superficial capillary plexus; SD-OCT, spectral-domain optical coherence tomography.
case_images: 10.1177_25158414241232261-fig3.jpg
case_images: PMC10894533_01_10.1177_25158414241232261-fig3.jpg
case_images: fig3-25158414241232261
case_images: Although the foveal depression was present, thinning/collapse of the outer nuclear layer and coalescence of the rest of retinal layers was observed in the foveola [Figure 3(c)]. OCT-angiography (OCTA) in this stage [Figure 3(a) and (b)]. One month after surgery, patient's BCVA was 6/19 but on SD-OCT schistic spaces throughout the macula had moderately increased [Figure 3(f)]. Areas of reduced density were observed in OCTA in the deep capillary plexus (DCP) accompanied by flow voids in the choriocapillaris (CCP) layer mainly nasally as well as inferiorly, corresponding to the areas where schisis had reappeared [Figure 3(d) and (e)]. Three months post-operatively, in spite of a substantial deterioration regarding the size of schisis cavities, and while schisis had now involved the fovea [Figure 3(i)], BCVA remained stable at 6/15. Previously noted DCP and CCP flow void areas had increased possibly corresponding to shadowing effect from the schistic spaces located between inner plexiform layer (IPL) and outer plexiform layer (OPL) together with artifacts from SO [Figure 3(g) and (h)].