Retinoschisis is a pathological change in the retina, in which there is a separation of the retinal layers into external (choroidal) and internal (vitreal). The main cause of development is considered to be a violation of blood circulation in the retina. There are no clinical manifestations in the early stages of retinoschisis, symptoms occur only with the development of complications in the form of decreased visual acuity, narrowing of the visual fields. For diagnostics, visiometry, tonometry, ophthalmoscopy are used. Additional methods include ultrasound of the eye, electroretinography, fluorescence angiography, optical coherence tomography. Treatment can be conservative, laser or surgical.
Retinoschisis is a degenerative change in the retina, accompanied by its cystic degeneration, folding, tears, retinal detachment and changes in the vitreous body. The term retinoschisis was proposed in 1935. Pathology occurs as a result of malformations or dystrophic changes in the retinal membrane. The incidence rate in USA in people aged over 40 years ranges from 4 to 12%. Retinoschisis occurs in about 5% of the European population over the age of 30. The hereditary form manifests itself at the age of 10 years. The importance of the problem of diagnosis and treatment of retinoschisis is determined by the fact that in most cases there are no complaints in patients, the disease is diagnosed accidentally or after complications occur. Pathology is widespread everywhere.
- Degenerative retinoschisis. It is an acquired form of the disease. Occurs after the age of 40 years due to dystrophic changes in the retina of the eye. It occurs in two forms – typical and reticular (characterized by a large size of cysts in the retina).
- Hereditary retinoschisis. Develops as a result of genetic disorders. It can be linked to the X chromosome, transmitted by autosomal dominant or recessive type. Sometimes it is one of the symptoms of genetically determined pathologies, such as Goldman-Favre or Wagner disease.
- Secondary retinoschisis. It occurs with vascular diseases of the eyes (diabetic retinopathy, thrombosis of the central retinal vein), inflammatory processes (chronic forms of uveitis, iridocyclitis), injuries of the visual organ, oncological diseases of the vascular membrane, as a result of exposure to certain medications.
The pathogenesis is based on a violation of blood circulation in the macular region and on the periphery of the retina. Disorders in the retina manifest themselves in the form of cystic degeneration. The fusion of the formed cysts contributes to the formation of large cavities inside the retina, delaminating the retina throughout its entire length. The stratification zone may remain intact, but it may also be torn in one or even both sheets. This leads to the development of retinal detachment and the death of retinal structures.
- Stage I – retinal cleavage occurs in a limited area, vascular elevation and formation of intraretinal fluid around them.
- Stage II – there is a progression of splitting of the retinal membrane without a clear boundary between the retinoschisis and the unaffected retina. The formation of microcysts in the layers of the retina is noted.
- Stage III – retinoschisis occupies several quadrants with the presence of extensive cysts. There are ruptures of cavities under the retina. The pathological process can turn into a delimited retinal detachment.
Degenerative retinoschisis is usually asymptomatic. Pathology is detected accidentally during preventive examinations by an ophthalmologist. It is manifested by a lesion at the level of the outer plexiform layer of the retinal membrane. Primary changes occur on the extreme inferior temporal periphery and are characterized by the formation of extensive areas with small-cystic dystrophy in the retinal layers. When the process spreads to the macula or with the development of retinal detachment, there are complaints of decreased visual acuity, narrowing of the visual fields, distortion of objects, the appearance of flashes in front of the eyes.
Hereditary retinoschisis is more often diagnosed at the age of 7-9 years. The macular area is affected first of all, as a result, there are complaints of a decrease in central vision (difficulties in reading, writing, watching TV). The damage is localized at the level of Muller cells, as a result of which the layer of nerve fibers peels off from the rest of the retina. Peripheral disorders in the retina with retinoschisis are most often localized in the lower temporal quadrant, manifested by the development of giant oval cysts with subsequent formation of detachment. The lesion is bilateral.
Secondary retinoschisis is a complication of various diseases of the eyeball. Clinical manifestations depend on the underlying pathology. Complications of retinoschisis include the development of extensive detachments in the retina of the eye, hemorrhages under the retina, in cysts of the layered shell or in the vitreous.
To diagnose retinoschisis, basic examination methods are used: visiometry, tonometry, ophthalmoscopy using a slit lamp and a Goldman lens. To clarify the diagnosis, ultrasound of the eyeball, electroretinography (to determine the functional state of the retina), fluorescent angiography (to diagnose pathology in the macula, with congenital retinoschisis) are additionally prescribed. Computer perimetry helps to establish the presence of defects in the field of vision. Optical coherence tomography is the leading method for this pathology. It allows you to accurately identify changes in the macular region of the retina, determine the presence of cysts and detachments on the periphery. Differential diagnosis is performed with retinal detachment, Asgard dystrophy and retinal vasculitis.
Treatment of retinoschisis
Conservative, laser and surgical techniques are used for treatment. Conservative therapy is aimed at improving microcirculation and metabolic processes in the retina of the eye, it is prescribed to prevent the development of secondary retinoschisis. It includes the use of vitamin complexes, antioxidant and nootropic therapy. Methods of administration of drugs – intravenous or intramuscular. Treatment courses are recommended to be carried out 2 times a year.
Laser treatment is aimed at stopping the progression of retinoschisis that has already occurred. Barrier or translational laser coagulation of the retina is used. Coagulates are applied in the form of circles along the border with healthy areas of the fundus. Surgical treatment is necessary in the presence of an identified retinal detachment. Sclera filling is performed by various methods.
Prognosis and prevention
The prognosis for visual functions in the degenerative form of retinoschisis is always doubtful, with hereditary – unfavorable. The outcome of the secondary form of the disease depends on the underlying pathology. Prevention of retinoschisis consists in regular visits to an ophthalmologist, especially after 40 years. In the presence of a high degree of myopia, it is necessary to exclude as much as possible heavy physical exertion, stressful situations at work and at home. With open-angle glaucoma, it is necessary to regularly apply prescribed drops and monitor IOP every 3 months. With an increase in blood pressure, it is recommended to take medications to correct it. Eye and head injuries should be avoided. Regular visits to an ophthalmologist and strict compliance with his recommendations significantly reduces the risk of complications with retinoschisis and contributes to the long-term stabilization of the disease.