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Review
. 2023 Jul 14;23(1):318.
doi: 10.1186/s12886-023-03068-z.

Severe macular complications in glaucoma: high-resolution multimodal imaging characteristics and review of the literature

Hugo Lama  1 , Michel Pâques  2 , Emmanuelle Brasnu  2 , Jade Vu  1   3 , Céline Chaumette  2 , Bénédicte Dupas  1 , Christine Fardeau  1   4 , Ismaël Chehaibou  3 , Jean-François Rouland  5 , Guillaume Besombes  5 , Marc Labetoulle  1 , Antoine Labbé  2 , Antoine Rousseau  6
Affiliations
Review

Severe macular complications in glaucoma: high-resolution multimodal imaging characteristics and review of the literature

Hugo Lama et al. BMC Ophthalmol. .

Abstract

Purpose: To describe imaging characteristics of severe macular complications occurring in glaucoma and discuss available treatments.

Methods: Retrospective case series of glaucomatous patients with macular retinoschisis (MR) and/or serous retinal detachment (SRD). Patients underwent a complete ophthalmological examination and multimodal imaging including retinography, SD-OCT, fluorescein and indocyanine green angiography (FA & ICGA) and adaptive optics (AO).

Results: Ten eyes (8 patients) were included. Initial BCVA was 1.04 ± 1.12 logMAR and IOP was 24.0 ± 9.3mmHg. All eyes presented with MR while SRD was present in 5 eyes (5 patients), with a central macular thickness of 573 ± 152 μm. FA and ICGA allowed to exclude leakage in all cases. A focal lamina cribrosa defect (LCD) was found in four eyes (4 patients) using OCT, with AO providing en-face visualization of the defect in one eye. Outer retinal hole was present in 3 eyes (3 patients). No visual improvement or resolution of the macular retinoschisis was observed in eyes with medical or surgical IOP control (N = 9). Vitrectomy with internal membrane limiting peeling and gas tamponade was performed in one eye with good visual results.

Conclusions: Multimodal high-resolution imaging is essential to diagnose severe macular complications associated with advanced glaucoma.

Keywords: Adaptive optics; Glaucoma; High-resolution imaging; Macular edema; Retinoschisis; Serous retinal detachment.

PubMed Disclaimer

Conflict of interest statement

Pr Paques is consultant for Imagine Eyes. The other authors have no conflicting interest to disclose.

Figures

Fig. 1
Fig. 1
Case #1. (A) Color fundus photography of the left eye revealing retinoschisis associated with SRD (arrowheads) and complete optic disc cupping. (B) SD-OCT scans across the macula showing macular retinoschisis (arrow) with massive SRD (*) and an outer retinal hole (arrowhead). Yellow arrows highlight the absence of VM traction, with posterior hyaloid membrane remaining parallel to the retina, without conical pattern. C, D) Early and late phase fluorescein angiograms & E, F) early- and late-phase indocyanine green angiogram showing no leakage
Fig. 2
Fig. 2
Case #4. (A) SD-OCT scan showing macular retinoschisis (arrow) associated with SRD (*) and an outer retinal hole (arrowhead). (B) Lamina cribrosa defect on enhanced depth imaging SD-OCT scan (arrow), and (C) using AO imaging (white arrow)
Fig. 3
Fig. 3
(A) SD-OCT scan showing macular retinoschisis (arrow), (B) AO scan showing a spoke-wheel pattern at the level of the retinoschisis (*)
Fig. 4
Fig. 4
Proposed therapeutic algorithm for glaucoma-associated retinoschisis. IOP = intraocular pressure; SRD = serous retinal detachment; PPV = vitrectomy; PVD = posterior vitreous detachment; ILMP = internal limiting membrane peeling; BCVA = best corrected visual acuity
See this image and copyright information in PMC

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