Background: Senile retinoschisis with associated retinal detachment in the presence of multiple or large posterior outer layer breaks is rare. Despite many and significant developments in vitreoretinal surgery for this situation, no definitive therapeutic guidelines exist. In an observational study three different approaches performed by two of the authors are presented.
Methods: Eighteen eyes of 18 patients with symptomatic schisis detachment and large posterior outer layer breaks were analyzed retrospectively. The fovea was detached in six eyes. Four eyes had laser photocoagulation and/or transscleral cryopexy (Group I), and five eyes had extensive scleral buckling (Group II). In nine eyes primary vitrectomy and gas endotamponade were performed, including inner layer resection in two eyes (Group III). The median follow-up period was 13 months.
Results: Initial anatomic success, which was defined as complete reattachment of the outer retinal layer, was achieved in two of four eyes of Group I, in four of five eyes of Group II, and in seven of nine eyes of Group III. Inner layer separation persisted in 11 of 16 eyes. Visual acuity improved in 3 of 18 eyes, remained unchanged in 9 of 18 eyes, and worsened in 6 of 18 eyes. Complications included in Group I were persistent outer retinal layer detachment (two eyes); in Group II, proliferative vitreoretinopathy (PVR) detachment (one eye), CME (one eye), diplopia (one eye), late redetachment (one eye); in Group III, secondary rhegmatogenous detachment (one eye) PVR detachment (two eyes), macular pucker (one eye), preexisting CME (two eyes), subretinal perfluorocarbon liquid (one eye), transient central serous detachment (one eye), and nuclear sclerosis (five of eight eyes).
Conclusion: Photocoagulation alone may be considered a first approach in selected cases of schisis detachment complicated by large posterior outer layer breaks. By use of present surgical techniques, today pars plana vitrectomy is the most rational approach allowing an exact evaluation of the complex retinal architecture, a controlled coagulation, and an adequate tamponade of the involved area. Resection of the inner layer seems to increase the risk for epiretinal membrane formation.