Ophthalmology. Retina · 2025
Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis and Central Anomalous Retinoschisis with mid-PEripheral Traction.
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Feo Alessandro, Govetto Andrea, Ramtohul Prithvi, Abraham Néda, Cabral Diogo, Chang Peter Y, Chaudhry Nauman, Chen Fred K, Eliott Dean, Faes Livia, Heath Jeffery Rachael C, Mrejen Sarah, Popovic Marko M, Tieger Marisa G, Zatreanu Luca, Sadda SriniVas R, Freund K Bailey, Romano Mario R, Sarraf David
Аннотация
PURPOSE: To report the clinical and multimodal imaging (MMI) findings and long-term follow-up of stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) contiguous with midperipheral retinoschisis (MPRS) and to describe a severe SNIFR variant termed CARPET (Central Anomalous Retinoschisis with mid-PEripheral Traction).
DESIGN: Retrospective case series.
SUBJECTS: Eleven patients (15 eyes) with SNIFR contiguous with MPRS in at least 1 eye at baseline or final follow-up.
METHODS: Multimodal imaging features, including cross-sectional and en face macular and peripheral spectral-domain OCT and OCT angiography, were reviewed in all cases at baseline and at the final follow-up visit.
MAIN OUTCOME MEASURES: Various courses (including progression, regression, or stability) of MPRS or SNIFR over time were evaluated.
RESULTS: Midperipheral retinoschisis exhibited centripetal progression to SNIFR in 5 eyes of 3 patients with follow-up of 67, 60, and 27 months, respectively, with maintenance of excellent visual acuity (range: 20/25-20/20) in 4 of these 5 eyes. In 2 eyes of 2 patients (including 1 eye with initial centripetal progression of MPRS to SNIFR), MPRS contiguous with SNIFR spontaneously resolved with long-term follow-up (77 and 25 months, respectively). Stellate nonhereditary idiopathic foveomacular retinoschisis contiguous with MPRS partially regressed after 48 months in 1 patient, and was stable after 54 months in another. A distinctive midperipheral microvasculopathy, associated with MPRS that was contiguous with SNIFR, was identified in 7 eyes of 4 patients. Finally, 3 eyes of 3 patients exhibited additional unique features, including central neurosensory detachment and outer lamellar macular hole, which were associated with significant midperipheral traction, representing a severe variant subtype of SNIFR that we refer to as CARPET. Two of these 3 eyes progressed with short-term follow-up of 6 and 2 months, respectively, whereas the schisis resolved and vision improved after pars plana vitrectomy in the third case.
CONCLUSIONS: Midperipheral retinoschisis can progress to SNIFR over multiple years of follow-up. Stellate nonhereditary idiopathic foveomacular retinoschisis with MPRS can also spontaneously resolve or remain stable. Midperipheral retinoschisis can additionally be complicated by a midperipheral inner retinal microvasculopathy. Finally, CARPET may represent a unique and severe variant form of SNIFR driven by midperipheral vitreoretinal traction and associated with significant vision loss.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
DESIGN: Retrospective case series.
SUBJECTS: Eleven patients (15 eyes) with SNIFR contiguous with MPRS in at least 1 eye at baseline or final follow-up.
METHODS: Multimodal imaging features, including cross-sectional and en face macular and peripheral spectral-domain OCT and OCT angiography, were reviewed in all cases at baseline and at the final follow-up visit.
MAIN OUTCOME MEASURES: Various courses (including progression, regression, or stability) of MPRS or SNIFR over time were evaluated.
RESULTS: Midperipheral retinoschisis exhibited centripetal progression to SNIFR in 5 eyes of 3 patients with follow-up of 67, 60, and 27 months, respectively, with maintenance of excellent visual acuity (range: 20/25-20/20) in 4 of these 5 eyes. In 2 eyes of 2 patients (including 1 eye with initial centripetal progression of MPRS to SNIFR), MPRS contiguous with SNIFR spontaneously resolved with long-term follow-up (77 and 25 months, respectively). Stellate nonhereditary idiopathic foveomacular retinoschisis contiguous with MPRS partially regressed after 48 months in 1 patient, and was stable after 54 months in another. A distinctive midperipheral microvasculopathy, associated with MPRS that was contiguous with SNIFR, was identified in 7 eyes of 4 patients. Finally, 3 eyes of 3 patients exhibited additional unique features, including central neurosensory detachment and outer lamellar macular hole, which were associated with significant midperipheral traction, representing a severe variant subtype of SNIFR that we refer to as CARPET. Two of these 3 eyes progressed with short-term follow-up of 6 and 2 months, respectively, whereas the schisis resolved and vision improved after pars plana vitrectomy in the third case.
CONCLUSIONS: Midperipheral retinoschisis can progress to SNIFR over multiple years of follow-up. Stellate nonhereditary idiopathic foveomacular retinoschisis with MPRS can also spontaneously resolve or remain stable. Midperipheral retinoschisis can additionally be complicated by a midperipheral inner retinal microvasculopathy. Finally, CARPET may represent a unique and severe variant form of SNIFR driven by midperipheral vitreoretinal traction and associated with significant vision loss.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.