Macular schisis and detachment associated with presumed acquired enlarged optic nerve head cups.
OBJECTIVE
To describe a clinical syndrome of macular schisis and detachment in patients with acquired optic nerve head cupping resulting from glaucoma.


METHODS
Retrospective review of five patients.


METHODS
Patients were included if they had optic nerve cupping and macular schisis with or without detachment with no other identifiable cause. The patients had to have no leakage on fluorescein angiography and no vitreous traction on examination or on optic coherence tomography (OCT). These patients were followed up and visual acuity, intraocular pressure, and the findings of serial fundus and OCT examinations were noted.


RESULTS
Five patients had schisis with or without detachment of the macula with pronounced optic nerve head cupping. One patient had resolution of the macular fluid after filtering surgery for uncontrolled glaucoma. Two patients underwent a vitrectomy with intraocular gas and had almost total resolution of macular fluid and improved vision.


CONCLUSIONS
Macular schisis and detachment can occur in patients with presumed enlarged optic nerve head cups in the absence of obvious congenital anomalies of the disk. The authors believe the cause is leakage of fluid from the vitreous through a tiny hole in the thin tissue of the cup. This is a similar mechanism to that seen in patients with optic pits. A vitrectomy or steps to reduce the intraocular pressure may result in resolution of the fluid and improved vision.
Zumbro
David S
DS
Ophthalmology Service, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
Jampol
Lee M
LM
Folk
James C
JC
Olivier
Mildred M G
MM
Anderson-Nelson
Susan
S
D000293:Adolescent; D000368:Aged; D005260:Female; D018463:Filtering Surgery; D005451:Fluorescein Angiography; D005902:Glaucoma, Open-Angle / Q000150:complications*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000209:etiology*; D012163:Retinal Detachment / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D041441:Retinoschisis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D014821:Vitrectomy