Peripapillary Retinoschisis Mimicking Normal Retinal Nerve Fiber Layer

Abstract

A 43-year-old male patient came for routine evaluation. Best-corrected visual acuity was 20/20 in both eyes and intraocular pressure was 13 mm Hg in both eyes. No significant finding was noted in slitlamp biomicroscopy. Fundus examination revealed an optic disc with 0.6 excavation in the right eye and 0.4 in the left eye and subtle superior folds peripapillary in the internal limiting membrane in the right eye (Fig. 1A). In the optical coherence tomography evaluation, we observed abnormal thickening of the retinal nerve fiber layer and also schisis within the inner and outer retina (Fig. 1B-E), confirming the diagnostic of peripapillary retinoschisis (PPRS).In general, PPRS are hardly seen in optic disc color photograph, since patients may present thick normal retinal nerve fiber layer, however in this case, subtle folds in the internal limiting membrane (Fig. 1A) were observed. PRRS can be detected in 6% of patients with diagnosed glaucoma or glaucoma suspects and are related to Muller cell dysfunction. 1,2 It is important to use both glaucoma and retinal optical coherence tomography scan protocols placed on the optic nerve to properly detect and monitor changes in the patterns of the schisis over time.