40
QUESTION
HOW DO YOU DIFFERENTIATE BETWEEN RETINOSCHISIS AND RETINAL DETACHMENT?
Scott Ketner, MD
Ron A. Adelman, MD, MPH, MBA, FARVO
Retinoschisis is a splitting of the retinal layers, most often at the outer plexiform layer or the nerve fiber layer.1–3 By contrast, a retinal detachment is a separation of the neurosensory retina from the retinal pigment epithelium (RPE).
Peripheral, degenerative retinoschisis is thought to develop with the coalescence of cystic lesions in areas of peripheral cystoid degeneration, as the degeneration of neuroretinal and glial supporting elements allows a splitting to occur within the retinal layers. The newly created space fills with a mucopolysaccharide substance.1–3 By contrast, a retinal detachment (ie, a rhegmatogenous retinal detachment [RRD]) develops when fluid from the vitreous cavity gains access, via a retinal break, to the potential space between the neurosensory retina and RPE.
Retinoschisis rarely progresses posteriorly to encroach on the macula and can usually be observed. Attempts to treat schisis with laser barricade to prevent posterior progression are likely to be ineffective and can expose the patient to unnecessary risks.4–7 A RRD, by contrast, almost always progresses if left treated. In rare cases, in which both an inner and outer retinal hole develop within an area of schisis, a schisis can cause a retinal detachment; fortunately, this is rare.4
Peripheral retinoschisis can resemble a RRD. Both can appear as elevated peripheral lesions; however, the following characteristics can help differentiate the 2 (Table 40-1).
Table 40-1
Summarizing Distinguishing Features of Retinoschisis and Retinal Detachment
NFL = nerve fiber layer; OPL = outer plexiform layer; OCT = optical coherence tomography
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
