Vitrectomy for Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis Associated With Outer Retinal Layer Defect

Abstract

Purpose: To describe a case of stellate nonhereditary idiopathic foveomacular retinoschisis associated with outer retinal layer defect treated with pars plana vitrectomy, internal limiting membrane removal, and C3F8 tamponade.Methods: Spectral-domain optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany) scans of a 46-year-old woman with unilateral stellate nonhereditary idiopathic foveomacular retinoschisis were acquired at baseline and 1, 3, 6, and 12 months after surgery.Results: Pars plana vitrectomy was performed after phacoemulsification. The vitreous was circumcised, and the internal limiting membrane was removed with a Tano brush, releasing tangential forces. The patient experienced progressive recovery of the outer retinal layers and improvement of visual acuity during follow-up.Conclusion: Stellate nonhereditary idiopathic foveomacular retinoschisis may be associated with outer retinal layer defect and severe vision loss. Pars plana vitrectomy with internal limiting membrane removal and C3F8 infusion seems to be a safe and feasible treatment in such cases, with potentially good anatomical and functional outcome.

An Association Between Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis, Peripheral Retinoschisis, and Posterior Hyaloid Attachment

“…Several subsequent case studies have attributed findings of FRS to SNIFR, some of which have evidence of concurrent extramacular schisis, with associated features suggestive of both vitreoretinal adhesion and PRS (although these was not always considered of primary relevance in these reports). [19][20][21][22] Considering these factors, along with our findings, we hypothesize that there may be both a tractional element at the vitreoretinal interface resulting in FRS in eyes with SNIFR, as well as an association with PRS.…”

“…Moreover, it is likely that surgical induction of PVD and removal of the posterior hyaloid would be hampered by both the retinoschisis itself and tight vitreoretinal adhesion, which could increase the rate of intra-operative complication or surgical failure. 22 This study is limited by the retrospective design, resulting in incomplete collection of data, such as refractive error, axial length or investigations, including genetic testing or fluorescein or OCT angiography. In this regard, we are not in a position to explore certain associations, such as the relationship between refractive error and SNIFR, or confirm a definite absence of inherited or exudative pathology.…”

Stellate nonhereditary idiopathic foveomacular retinoschisis and an approach to the differential diagnosis of macular star

“…In the largest SNIFR case series to date, 86% of eyes showed an anomalous or incomplete posterior vitreous detachment (PVD), compared with 42% of unaffected fellow eyes [2 ▪▪ ]. Interestingly, multiple reports of surgical intervention for SNIFR or similar forms of foveomacular retinoschisis have noted abnormally adherent posterior hyaloid or internal limiting membrane (ILM) [4,14–16]. This tractional hypothesis is further supported by reports of improvement in retinoschisis after spontaneous release of vitreomacular adherence.…”

“…]. Interestingly, multiple reports of surgical intervention for SNIFR or similar forms of foveomacular retinoschisis have noted abnormally adherent posterior hyaloid or internal limiting membrane (ILM) [4,[14][15][16]. This tractional hypothesis is further supported by reports of improvement in retinoschisis after spontaneous release of vitreomacular adherence.…”

“…Bevacizumab has been coincidentally used in patients with SNIFR without significant improvement [7,48,49]. Pars plana vitrectomy with ILM peel has been described in select patients with idiopathic foveomacular retinoschisis [4,[14][15][16]. In each of these patients, visual effects were progressive and more severe than SNIFR and imaging showed evidence of more obvious tractional pathophysiology, arguing more for a diagnosis of VMT rather than true SNIFR.…”