American journal of ophthalmology · 2026
Bullous Peripheral Retinoschisis: Structural Biomarker for Complications in X-Linked Retinoschisis via Ultrawide-Field Swept Source Optical Coherence Tomography.
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Zhang Linyan, Li Songshan, Sun Limei, Liu Xinyu, Cheng Yizhe, Ke Shuya, Li Jiaqing, Ding Xiaoyan
Аннотация
PURPOSE: To characterize bullous peripheral retinoschisis (BPR) using Ultrawide-Field swept source optical coherence tomography (UWF SS-OCT) and evaluate its association with complications in X-linked retinoschisis (XLRS).
DESIGN: Retrospective cross-sectional study.
SUBJECTS: A total of 145 eyes from 80 genetically confirmed XLRS patients.
METHODS: Eighty male patients (145 eyes) with genetically confirmed XLRS underwent UWF SS-OCT imaging. BPR parameters (horizontal/vertical maximum angle of peripheral retinoschisis, area ratio, distance to fovea) were quantified. Factors associated with complications (vitreous hemorrhage, choroidal neovascularization, macular atrophy/fold, and secondary cataract) were analyzed.
RESULTS: BPR prevalence was 65.5% (95/145 eyes), predominantly involving the inferotemporal retina (97.9% inferior, 100% temporal), with 52.6% spanning three quadrants. Eyes with complications (26.2%, 38/145) presented younger (4.0 [IQR: 3.3-5.8] vs 5.0 [IQR: 4.0-8.0] years; P = .019), worse best corrected visual acuity (1.12 ± 0.67 vs 0.72 ± 0.44 logarithm of the minimal angle of resolution, P < .001), larger horizontal maximum angle of peripheral retinoschisis and vertical maximum angle of peripheral retinoschisis (60.18 ± 28.80° vs 30.61 ± 30.30°, P < .001; 54.42 ± 22.21° vs 31.90 ± 32.27°, P < .001), higher BPR-to-fundus area ratio (0.40 ± 0.15 vs 0.27 ± 0.18; P < .001), and shorter BPR-to-fovea distance (2897.24 ± 2184.48 µm vs 4776.7 ± 2431 µm, P < .001). BPR prevalence was higher in the complication group (89.5% vs 57.0%, P < .001). Receiver operating characteristic analysis revealed BPR discriminated vitreous hemorrhage with area under the curve 0.789 (95% CI: 0.710-0.869). Choroidal neovascularization exclusively co-occurred with BPR and correlated with proximity to fovea (P = .041). Genetic variants showed no association with complications.
CONCLUSIONS: BPR is a hallmark of pediatric XLRS, strongly linked to complications via structural severity (angles, area, foveal proximity). UWF SS-OCT enables early detection and risk stratification, guiding targeted monitoring.
DESIGN: Retrospective cross-sectional study.
SUBJECTS: A total of 145 eyes from 80 genetically confirmed XLRS patients.
METHODS: Eighty male patients (145 eyes) with genetically confirmed XLRS underwent UWF SS-OCT imaging. BPR parameters (horizontal/vertical maximum angle of peripheral retinoschisis, area ratio, distance to fovea) were quantified. Factors associated with complications (vitreous hemorrhage, choroidal neovascularization, macular atrophy/fold, and secondary cataract) were analyzed.
RESULTS: BPR prevalence was 65.5% (95/145 eyes), predominantly involving the inferotemporal retina (97.9% inferior, 100% temporal), with 52.6% spanning three quadrants. Eyes with complications (26.2%, 38/145) presented younger (4.0 [IQR: 3.3-5.8] vs 5.0 [IQR: 4.0-8.0] years; P = .019), worse best corrected visual acuity (1.12 ± 0.67 vs 0.72 ± 0.44 logarithm of the minimal angle of resolution, P < .001), larger horizontal maximum angle of peripheral retinoschisis and vertical maximum angle of peripheral retinoschisis (60.18 ± 28.80° vs 30.61 ± 30.30°, P < .001; 54.42 ± 22.21° vs 31.90 ± 32.27°, P < .001), higher BPR-to-fundus area ratio (0.40 ± 0.15 vs 0.27 ± 0.18; P < .001), and shorter BPR-to-fovea distance (2897.24 ± 2184.48 µm vs 4776.7 ± 2431 µm, P < .001). BPR prevalence was higher in the complication group (89.5% vs 57.0%, P < .001). Receiver operating characteristic analysis revealed BPR discriminated vitreous hemorrhage with area under the curve 0.789 (95% CI: 0.710-0.869). Choroidal neovascularization exclusively co-occurred with BPR and correlated with proximity to fovea (P = .041). Genetic variants showed no association with complications.
CONCLUSIONS: BPR is a hallmark of pediatric XLRS, strongly linked to complications via structural severity (angles, area, foveal proximity). UWF SS-OCT enables early detection and risk stratification, guiding targeted monitoring.