Pars plana vitrectomy in progressive severe stellate non-hereditary idiopathic foveomacular retinoschisis (SNIFR): surgical outcomes and considerations for pathophysiology

Omar M Moinuddin; Remo Turchetti Moraes; Beatriz Klejnberg Moraes; Eduardo Cunha de Souza; Octaviano Magalhaes Junior; Nadyr Damasceno; Hélio P Primiano Júnior; Antonio Capone Jr; Antonio Marcelo B Casella; Tamer H Mahmoud

doi:10.1186/s40942-025-00742-w

Pars plana vitrectomy in progressive severe stellate non-hereditary idiopathic foveomacular retinoschisis (SNIFR): surgical outcomes and considerations for pathophysiology

Int J Retina Vitreous. 2025 Oct 24;11(1):116. doi: 10.1186/s40942-025-00742-w.

Affiliations

¹ Associated Retinal Consultants, P.C., Royal Oak, MI, USA.
² Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
³ Brazilian Institute of Ophthalmology, Rio de Janeiro, Brazil.
⁴ Ophthalmology Division, São José do Rio Preto Medical School, São José do Rio Preto, Brazil.
⁵ Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.
⁶ Department of Ophthalmology, Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil.
⁷ Department of Ophthalmology, Universidade Estadual de São Paulo, São Paulo, Brazil.
⁸ Department of Surgery, Universidade Estadual de Londrina, Londrina, Brazil.
⁹ Associated Retinal Consultants, P.C., Royal Oak, MI, USA. thmahmoud@yahoo.com.
¹⁰ Oakland University William Beaumont School of Medicine, Rochester, MI, USA. thmahmoud@yahoo.com.

Abstract

Background: To report the clinical course and outcomes of a surgical approach for progressive severe stellate non-hereditary idiopathic foveomacular retinoschisis (SNIFR) using pars plana vitrectomy (PPV).

Methods: Multi-center, consecutive, interventional case series. Patients with a diagnosis of SNIFR presenting with progressive loss of vision between January 1, 2017 and January 1, 2023. Evaluation of ophthalmologic findings and multimodal ocular imaging at the time of diagnosis, surgical procedure, and of visual and anatomic outcomes postoperatively. The main outcome measures evaluated include best corrected visual acuity (BCVA), central macular thickness (CMT), and findings on optical coherence tomography (OCT).

Results: Seven patients diagnosed with SNIFR were included. Median age in years at the time of diagnosis was 64 (range, 46-77). Four patients were female, and three were male. Genetic testing for mutations in retinoschisin 1 (RS1) and for other inherited conditions associated with foveomacular retinoschisis was negative. All patients demonstrated progressive and severe retinoschisis, as well as worsening vision loss and metamorphopsia when managed conservatively. PPV was performed and revealed anomalously broad and dense adherence of the posterior hyaloid in all eyes. The internal limiting membrane (ILM) was peeled in all but one case. Median BCVA at baseline measured 20/50, and declined to 20/70 at the time of surgery. Median preoperative CMT measured 561 μm, with OCT demonstrating prominent retinoschisis of the outer plexiform and outer nuclear layers. All eyes demonstrated postoperative resolution of retinoschisis and subretinal fluid, with corresponding improvements in both BCVA and subjective central visual distortion up to six months after surgery. BCVA for the entire cohort improved to a median of 20/30, and with a corresponding decrease in CMT to a median of 240 μm.

Conclusion: PPV is an effective surgical intervention resulting in anatomic resolution of retinoschisis and improved functional vision in eyes with progressive and severe SNIFR.

Keywords: Foveomacular schisis; Hyaloid; Idiopathic; Internal limiting membrane; Macular thickness; Membrane peel; Pars plana vitrectomy; Retinoschisis.