Morphofunctional evaluation of peripapillary retinoschisis associated with myopic posterior staphyloma and hyaloid traction: does it cause peripapillary vitreoretinal traction?

Abstract

This case report presents the details of a 33-year-old female patient who was referred to a specialized retina service because of mild vision loss in her right eye). The patient's visual acuity was 20/25 in right eye and 20/50 in the left eye (; amblyopic); the spherical equivalent was -12.75 diopters (right eye) and -14.75 diopters (left eye). Multimodal retinal imaging showed peripapillary schisis in both the inner and outer retinal layers, grade II posterior vitreous detachment, and a tessellated fundus. Using Humphrey perimetry and MP-3 microperimetry, the functional evaluation indicated macular sensitivity within normal limits and decreased sensitivity in the peripapillary region, especially in right eye. The pattern-re versal visual evoked potential was measured. The N75 and P100 latency and amplitude in right eye were within normal values for checks of 1º. However, the amplitude was low for checks of 15'. Highly myopic patients who have posterior staphyloma that involves the optic nerve are susceptible to posterior hyaloid traction, and the resulting peripapillary vitreous traction may compromise vision.

Figure 1

(A) Ultra-wide-feld (UWF) retinography shows peripapillary posterior staphyloma with peripheral microcytic degeneration. (B) Retinography of 45° indicates mild disc pallor; mild difuse rarefaction of the retinal pigment epithelium (RPE), with great evidence of the choroidal vessels; and 360° peripapillary atrophy (small continuous arrow). (C) Red-free image shows a hyperreflective area indicating atrophy of the peripapillary RPE (small continuous arrow). (D) SS-OCT reveals maintenance of vitreous attachment to the optic nerve (arrowhead), with cleavage of the peripapillary outer retinal layers characteristic of peripapillary retinoschisis (dotted arrow) and RPE atrophy (continuous arrow). (E) Fluorescein angiography shows the peripapillary window defect.

Figure 2

(F, G) Blind spot enlargement is shown on 24-2 and 10-2 automated perimetry of OD and OS. (H, I) Microperimetry indicates normal and decreased macular and peripapillary sensitivity, respectively. (J) Reversal visual evoked potential of OD shows N75 and P100 latency and an amplitude within normal values for checks of 1°, as well as normal latency but low amplitude for checks of 15′.