13.2  Macular Hole Retinal Detachment

In retinoschisis detachments, the combination of inner and outer leaf breaks leads to retinal detachment. The difficulty in repairing a retinoschisis detachment is the firm adherence of the vitreous to the inner retinal leaf.

Common Causes

  1. Degenerative (“senile”) retinoschisis (Figure 13.3.1, Figure 13.3.2A & Figure 13.3.2)
  2. X-lined juvenile retinal retinoschisis. Recurrent vitreous hemorrhage occasionally accompanies this condition
  3. Myopic retinoschisis (Figure 13.3.3)
  4. Congenital disorders: ROP, FEVR
  5. Retinoschisis secondary to chronic epi-retinal traction
Figure 13.3.1 Degenerative Retinoschisis with a Large Outer Hole Break Leading to a Concurrent Rhegmatogenous Retinal Detachment

Figure 13.3.1 Degenerative Retinoschisis with a Large Outer Hole Break Leading to a Concurrent Rhegmatogenous Retinal Detachment

Figure 13.3.2
A: A Large Outer Retinal Hole Leading to a Detachment in an Underlying Retinoschisis
B: An OCT image of the Tear with Underlying Schisis

Figure 13.3.2 A

A

Figure 13.3.2 B

B

Figure 13.3.2
A: A Large Outer Retinal Hole Leading to a Detachment in an Underlying Retinoschisis
B: An OCT image of the Tear with Underlying Schisis

Figure 13.3.3 Vitrectomy for Myopic Retinoschisis

Figure 13.3.3 Vitrectomy for Myopic Retinoschisis

Surgery Versus Observation

Some schisis detachments may progress slowly, particularly inferior detachments, and if only an outer leaf break is visualized. If the retinal detachment is already demarcated by pigmentation, observation may be discussed with the patient. Use OCT directed at the edge of the detachment to document stability vs. progression.

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