Rhegmatogenous Retinal Detachment Due to Paravascular Linear Retinal Breaks Over Patchy Chorioretinal Atrophy in Pathologic Myopia

Abstract

To characterize posterior paravascular linear retinal breaks over areas of patchy chorioretinal atrophy as a cause of retinal detachment among patients with pathologic myopia.Methods: In this retrospective case series, we evaluated 10 pathologically myopic eyes having rhegmatogenous retinal detachment associated with posterior paravascular linear retinal breaks.Results: Ten eyes with posterior paravascular linear retinal breaks and retinal detachment were identified from January 1, 2008, to July 31, 2009. The retinal breaks were most frequently found along the inferotemporal vascular arcade, followed by the superotemporal arcade. The length of the breaks ranged from 0.25 to 1 disc diameter, and their distance from the optic disc ranged from 1 to 5 disc diameters. These paravascular linear retinal breaks have distinct clinical characteristics, including a strong propensity to occur over areas of patchy chorioretinal atrophy, a linear shape that is oriented parallel to the adjacent retinal vessels, and a tendency to result in progressive retinal detachment. Vitrectomy with gas tamponade was performed in all cases, and retinal reattachment was achieved in 9 cases by a single operation.Conclusions: Paravascular linear retinal breaks over areas of patchy chorioretinal atrophy represent a distinct clinical entity that can result in a special category of retinal detachment among patients with pathologic myopia. These breaks are apt to elude detection before surgery, and a careful search along the posterior vascular arcades during vitrectomy may help to detect these abnormalities. Pars plana vitrectomy with photocoagulation and intraocular tamponade may lead to a resolution of such rhegmatogenous retinal detachments.

Retinal detachment due to paravascular abnormalities-associated breaks in highly myopic eyes

“…The shape was consistent with the postulation that they developed from lamellar holes, which in turn came from retinal cysts after the inner lining rupture. In addition, unlike described in reports by Chen et al [6] and Rizzo et al [8], some of the breaks in our series were locate inside the arcade and were not necessarily located over areas of patchy chorioretinal atrophy or at the edge of staphyloma. In fact, all posterior breaks in our series were within the staphyloma.…”

“…Many of these breaks were difficult to see before surgery. Although the description and images presented by Chen et al [6] did resemble some of our cases, the authors did not relate the breaks with PVAs. Rizzo et al [8] recently reported 3 cases of RD due to paravascular or juxtapapillary breaks in pathological myopia.…”

“…Dugas et al [14] studied the cases of RD in highly myopic eyes with axial length >30 mm and found posterior paravascular breaks in 11 out of the 67 cases. Chen et al [6] reported 10 cases of RD due to posterior paravascular breaks in pathological myopia. In their case series, the breaks were all linear-shaped without operculum, located along the posterior vascular arcades, at the edge of posterior staphyloma, and over the areas of patchy chorioretinal atrophy.…”

Retinal detachment due to paravascular abnormalities-associated breaks in highly myopic eyes

“…The shape was consistent with the postulation that they developed from lamellar holes, which in turn came from retinal cysts after the inner lining rupture. In addition, unlike described in reports by Chen et al [6] and Rizzo et al [8], some of the breaks in our series were locate inside the arcade and were not necessarily located over areas of patchy chorioretinal atrophy or at the edge of staphyloma. In fact, all posterior breaks in our series were within the staphyloma.…”

“…Many of these breaks were difficult to see before surgery. Although the description and images presented by Chen et al [6] did resemble some of our cases, the authors did not relate the breaks with PVAs. Rizzo et al [8] recently reported 3 cases of RD due to paravascular or juxtapapillary breaks in pathological myopia.…”

“…Dugas et al [14] studied the cases of RD in highly myopic eyes with axial length >30 mm and found posterior paravascular breaks in 11 out of the 67 cases. Chen et al [6] reported 10 cases of RD due to posterior paravascular breaks in pathological myopia. In their case series, the breaks were all linear-shaped without operculum, located along the posterior vascular arcades, at the edge of posterior staphyloma, and over the areas of patchy chorioretinal atrophy.…”

Swept-Source OCT En Face Imaging of Paravascular Inner Retinal Defects

“…Whether PIRDs progress to full-thickness retinal breaks that eventually lead to retinal detachment has not been studied longitudinally. Studies have shown retinal detachments in myopic eyes could originated from small and linear paravascular retinal tears in the posterior pole 9,10. Interestingly, these small and linear retinal breaks are exactly the shape and location of PIRDs on en face OCT imaging.…”

Amniotic membrane for retinal detachment due to paravascular retinal breaks over patchy chorioretinal atrophy in pathologic myopia

“…Chen et al 10 and Dinah et al 9 proposed an internal approach to RD in high myopic eyes associated with paravascular or juxtapapillary retinal microhole using laser retinopexy around the breaks and long-term gas tamponade with good anatomical results.…”

Retinal detachment due to paravascular abnormalities-associated breaks in highly myopic eyes

“…The shape was consistent with the postulation that they developed from lamellar holes, which in turn came from retinal cysts after the inner lining rupture. In addition, unlike described in reports by Chen et al [6] and Rizzo et al [8], some of the breaks in our series were locate inside the arcade and were not necessarily located over areas of patchy chorioretinal atrophy or at the edge of staphyloma. In fact, all posterior breaks in our series were within the staphyloma.…”

“…Many of these breaks were difficult to see before surgery. Although the description and images presented by Chen et al [6] did resemble some of our cases, the authors did not relate the breaks with PVAs. Rizzo et al [8] recently reported 3 cases of RD due to paravascular or juxtapapillary breaks in pathological myopia.…”

“…Dugas et al [14] studied the cases of RD in highly myopic eyes with axial length >30 mm and found posterior paravascular breaks in 11 out of the 67 cases. Chen et al [6] reported 10 cases of RD due to posterior paravascular breaks in pathological myopia. In their case series, the breaks were all linear-shaped without operculum, located along the posterior vascular arcades, at the edge of posterior staphyloma, and over the areas of patchy chorioretinal atrophy.…”

Swept-Source OCT En Face Imaging of Paravascular Inner Retinal Defects

“…Whether PIRDs progress to full-thickness retinal breaks that eventually lead to retinal detachment has not been studied longitudinally. Studies have shown retinal detachments in myopic eyes could originated from small and linear paravascular retinal tears in the posterior pole 9,10. Interestingly, these small and linear retinal breaks are exactly the shape and location of PIRDs on en face OCT imaging.…”

Amniotic membrane for retinal detachment due to paravascular retinal breaks over patchy chorioretinal atrophy in pathologic myopia

“…Chen et al 10 and Dinah et al 9 proposed an internal approach to RD in high myopic eyes associated with paravascular or juxtapapillary retinal microhole using laser retinopexy around the breaks and long-term gas tamponade with good anatomical results.…”

Retinal detachment due to paravascular abnormalities-associated breaks in highly myopic eyes

“…The shape was consistent with the postulation that they developed from lamellar holes, which in turn came from retinal cysts after the inner lining rupture. In addition, unlike described in reports by Chen et al [6] and Rizzo et al [8], some of the breaks in our series were locate inside the arcade and were not necessarily located over areas of patchy chorioretinal atrophy or at the edge of staphyloma. In fact, all posterior breaks in our series were within the staphyloma.…”

“…Many of these breaks were difficult to see before surgery. Although the description and images presented by Chen et al [6] did resemble some of our cases, the authors did not relate the breaks with PVAs. Rizzo et al [8] recently reported 3 cases of RD due to paravascular or juxtapapillary breaks in pathological myopia.…”

“…Dugas et al [14] studied the cases of RD in highly myopic eyes with axial length >30 mm and found posterior paravascular breaks in 11 out of the 67 cases. Chen et al [6] reported 10 cases of RD due to posterior paravascular breaks in pathological myopia. In their case series, the breaks were all linear-shaped without operculum, located along the posterior vascular arcades, at the edge of posterior staphyloma, and over the areas of patchy chorioretinal atrophy.…”

Swept-Source OCT En Face Imaging of Paravascular Inner Retinal Defects

“…Whether PIRDs progress to full-thickness retinal breaks that eventually lead to retinal detachment has not been studied longitudinally. Studies have shown retinal detachments in myopic eyes could originated from small and linear paravascular retinal tears in the posterior pole 9,10. Interestingly, these small and linear retinal breaks are exactly the shape and location of PIRDs on en face OCT imaging.…”

Amniotic membrane for retinal detachment due to paravascular retinal breaks over patchy chorioretinal atrophy in pathologic myopia

“…Chen et al 10 and Dinah et al 9 proposed an internal approach to RD in high myopic eyes associated with paravascular or juxtapapillary retinal microhole using laser retinopexy around the breaks and long-term gas tamponade with good anatomical results.…”