Peripheral retinal neovascularization secondary to highly myopic superficial Retinoschisis: a case report

Abstract

Background: Peripheral Retinal neovascularization is well-described as a complication of X-linked retinoschisis, but less often observed in myopic and primary retinoschisis. We present a case of a myopic female who developed retinal microvascular abnormalities due to retinoschisis and subsequent vitreous hemorrhage which would cause severe visual damage without timely and proper treatment.

Case presentation: A 38-year-old highly myopic Chinese female complained of blurred vision in her right eye. Her best corrected visual acuitiy was 20/20 OU, and her refraction was - 9.00S OU. Dilated fundus examination revealed mild vitreous hemorrhage and abnormal vascular network nasal to the optic disc in her right eye. Optical Coherence Tomography (OCT)- angiography (OCTA) B-Scan showed superficial retinoschisis and well-depicted abnormal retinal microvascular network in inner retinal layer. Sectoral scatter laser photocoagulation was administered. Regression of most abnormal vessels was achieved in 1 month, but the patient experienced an unexpected episode of vitreous hemorrhage 3 months after the initial treatment, which was absorbed spontaneously in 2 weeks. Supplemental laser photocoagulation was applied and regular follow-up visit was suggested.

Conclusion: Superficial retinoschisis in pathological myopia can be a driver of retinal microvascular abnormalities, possibly neovascularization, an extremely rare but severe complication which can be vision-threatening without timely and proper intervention.

Keywords: Pathological myopia; Retinal microvascular abnormalities; Retinal neovascularization; Retinoschisis.

Fig. 1

Multi-model imaging applied to the patient in her first visit. a Scanning laser ophthalmoscopy (SLO) showing fine, tortuous inter-connecting vascular network (white arrows) in the superficial layer of the retina nasal to the optic disc in her right eye. b Fluorescein fundus angiography (FFA) showing abnormal aneurysmal vessel network (white arrows) with obvious fluorescein leakage (asterisk marks). c Color fundus photography taken immediately after sectoral scatter laser photocoagulation. d and e Well-depicted retinal neovascularization at the level of retinal nerve fiber layer (NFL, white arrow) and ganglion cell layer (GCL, yellow arrow) overlying retinoschisis in optical coherence tomography angiography (OCTA) B-Scan. f Normal OCT B-Scan in other quatrants. g En-face OCTA showing fine inter-connecting vascular network (white arrow)

Fig. 2

Ophthalmic imaging of follow-up visit. a Regression of most retinal neovascularization confirmed by scanning laser ophthalmoscopy (SLO) during the 2nd visit. b SLO image after supplemental laser coagulation in the 3rd visit. c and d Remaining retinoschisis and aneurysmal structure (white arrow) showed by en-face optical coherence tomography angiography (OCTA) and OCTA B-Scan in the 3rd visit