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Peripapillary schisis in glaucoma patients with narrow angles and increased intraocular pressure.

Kahook MY, Noecker RJ, Ishikawa H, Wollstein G, Kagemann L, Wojtkowski M, Duker JS, Srinivasan VJ, Fujimoto JG, Schuman JS

UPMC Eye Center, Eye and Ear Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.

PURPOSE: To describe two cases of peripapillary retinal schisis in patients with glaucoma without evidence of optic nerve pits, pseudopits, or X-linked retinoschisis. DESIGN: Two observational case reports and literature review. METHODS: Imaging of the peripapillary nerve fiber layer and schisis cavities was completed in two patients, and one patient was followed over time. RESULTS: The first patient, diagnosed with narrow angle glaucoma, was noted to have peripapillary schisis in the right eye with matching changes on visual field and optical coherence tomographic (OCT) results. Follow-up examination revealed that the schisis disappeared in the right eye while appearing in the left. The findings were verified with high-speed ultra-high-resolution OCT performed in both eyes. The second case involved a patient with anatomically narrow angles, high intraocular pressure (IOP), and peripapillary schisis extending into the macula. CONCLUSIONS: Peripapillary retinoschisis may represent a unique sequelae of intraocular fluctuations in patients with uncontrolled glaucoma. Further studies are needed to better understand this disease process.

Published 27 March 2007 in Am J Ophthalmol, 143(4): 697-9.
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