Representative images show an internal limiting membrane (ILM) detachment in the inferior peripheral macula in an eye with a foveal retinal detachment (Patient 1). The best-corrected visual acuity is 0.2. (Top left, and Middle left) Infrared fundus photographs show the green scan lines of the enhanced spectral-domain optical coherence tomography (SD-OCT, Spectralis HRA+OCT) images in Top, and Middle right, respectively. The red and blue arrows indicate the points at which the scan line crosses the retinal vessels, which correspond to the red and blue arrowheads, respectively, in Top right. (Top, and Middle right) Vertical and horizontal 9-mm enhanced SD-OCT B-scans show macular retinoschisis and a foveal retinal detachment. (Top right) The ILM detachment (white arrows) and inner nuclear layer schisis are seen between the red arrowheads in the inferior peripheral macula along the vertical scan. The superior point (blue arrow) corresponding to a retinal arteriole does not show any features such as a retinal microfold or ILM detachment. Multiple columnar structures are seen in the hyporeflective spaces within the ILM detachment and outer retinoschisis. (Bottom) The magnified (2×) view of the area outlined by red dashed lines in the SD-OCT images in Middle right. A hyporeflective space with multiple columnar structures is present between the highly reflective outer plexiform layer (OPL) and highly reflective lines representing the external limiting membrane (ELM) and the photoreceptor inner and outer segment layer junction (IS/OS).

Representative images show an internal limiting membrane (ILM) detachment in the inferior and superior peripheral macula in an eye with foveal retinal detachment (Patient 11). The best-corrected visual acuity is 0.1. (Top left) Color fundus photograph. (Middle left) An infrared fundus photograph shows the red scan lines (*, †, and §). (Top, Middle, and Bottom center) Vertical (* and †) and horizontal (§) 6-mm enhanced spectral-domain optical coherence tomography (SD-OCT, Cirrus HD-OCT) images. (Top, Middle, and Bottom right) The magnified (2×) views of the areas outlined by red dashed lines in the SD-OCT images in Top, Middle, and Bottom center, respectively. The red and blue arrows (Middle left) indicate the points at which the scan line crosses the retinal vessels, which are indicated by the red and blue arrowheads (Top, and Middle center, and Middle right), respectively, in the vertical SD-OCT images. The vertical enhanced SD-OCT B-scans show macular retinoschisis and a foveal retinal detachment. The ILM detachment (white arrows) and inner plexiform layer (IPL) schisis are seen in areas including the retinal microfold at the point at which the scan crosses the retinal vessels, as shown by the red arrowhead in the inferior peripheral macula along a vertical scan. The crossing point indicated by the blue arrowhead does not show a retinal microfold. IPL schisis is also seen in the superior macula peripheral to the crossing point. Multiple columnar structures are evident in the hyporeflective spaces within the ILM detachment, IPL retinoschisis, and outer retinoschisis. A hyporeflective space with multiple columnar structures is present between the highly reflective outer plexiform layer (OPL) and highly reflective lines representing the external limiting membrane (ELM) and the photoreceptor inner and outer segment layer junction (IS/OS).

Images of an eye that progressed to a foveal retinal detachment without an internal limiting membrane (ILM) detachment (Patient 2). This is an exceptional case in which a foveal retinal detachment developed, but no ILM detachment was found at any time during the progression. The images from this case are shown because the entire process of foveal retinal detachment formation is well documented. (Top left) A color fundus photograph shows the scan lines (white lines) in Second, Third, Fourth, and Fifth row left. (Top center) An infrared fundus photograph shows multiple punctuate lesions corresponding to the columnar structures in the outer retinoschisis. (Top right) An infrared fundus photograph shows the green scan lines in Sixth row, and Bottom. (Second, Fourth, Fifth, and Sixth row left) Horizontal enhanced spectral-domain optical coherence tomography images. (Third row, and Bottom left) Vertical enhanced SD-OCT. (Second to Fifth row left) Six-mm-length B-scans in RTVue-100; (Sixth row, and Bottom left) 9-mm-length B-scans in Spectralis HRA+OCT. (Second, Third, Fourth, Fifth, and Sixth row right) Magnified (2×) views of the areas outlined by red dashed lines on SD-OCT images in Second, Third, Fourth, Fifth, and Sixth row left, respectively. The OCT images were obtained at the initial visit (Second row, and Third row), and 1 month (Fourth row), 2 months (Fifth row), and 5 months (Sixth row, and Bottom) after the initial visit. At the initial visit, the foveal photoreceptor layer appears intact based on the visibility of the highly reflective lines representing the external limiting membrane (ELM) and the photoreceptor inner and outer segment layer junction (IS/OS). At 1 month, a small area in the temporal juxtafovea shows a retinal detachment. At 2 months, the retinal detachment includes the whole fovea. At 5 months, the foveal detachment has enlarged, and consequent disruption of the outer photoreceptor layer is seen. The best-corrected visual acuity was 0.6, 0.6, 0.3, and 0.3 at the initial visit and at 1 month, 2 months, and 5 months after the initial visit, respectively. During progression to a foveal retinal detachment, the columnar structures indicated by white arrows gradually shrank and did not resemble a column. (Top left, and Top right) The red arrows point to where the scan lines cross the retinal vessels, indicated by red arrowheads in the vertical SD-OCT images (Third row, and Bottom). No ILM detachment or microfolds are seen.

Images from an eye that did not progress to a foveal retinal detachment for many years without internal limiting membrane detachment (Patient 14). (Top left) A color fundus photograph shows the scan lines (white lines) of optical coherence tomography (OCT) images in Top, Second, Third, and Fourth row right. (Top, Second, and Third row right) Time-domain (TD) OCT (Stratus OCT) B-scan images at the same horizontal scan. (Top right) The initial visit; (Second row right) 6 months after the initial visit; (Third right) 26 months after the initial visit. The white arrows indicate the central edge of the posterior hyaloid membrane detachment. The red arrows indicate the peripheral ends of the retinoschisis in the outer retina. As the posterior hyaloid membrane detachment progressed, the area of the retinoschisis narrowed, and the height of the foveoschisis appeared to increase, but no foveal detachment developed. (Second row left, and Fourth row right) Spectral-domain OCT (SD-OCT, Cirrus OCT) B-scans at the same location and time as the TD-OCT image in Third row right. (Second row left) A magnified (2×) view of the area outlined by red dashed lines in the SD-OCT images in Fourth row right. The highly reflective lines representing the external limiting membrane (ELM) and the photoreceptor inner and outer segment layer junction (IS/OS) is nearly intact. (Bottom left) An infrared image simultaneously obtained with SD-OCT images in (Fifth row, and Bottom right) horizontal (Fifth row right) and vertical (Bottom right) 9-mm length SD-OCT B-scan images (Spectralis HRA+OCT) obtained 33 months after the initial visit. The best-corrected visual acuity was stable during the 33 months (0.7, 0.7, 0.6, and 0.7 at the initial visit and at 6, 26, and 33 months after the initial visit, respectively). (Bottom left) The red and blue arrows indicate the points where the scan lines cross the vessels, indicated by (Bottom right) the red and blue arrowheads, respectively. There is a microfold (red arrowhead) at a point corresponding to the retinal vessel but no ILM detachment.