Macula and Retina Institute

Purpose: Peripapillary and macular retinoschisis can occur without visible optic pits or advanced glaucomatous optic atrophy, a condition referred to as no optic pit retinoschisis (NOPIR). This study sought to further define the clinical features of NOPIR in a single-center case series. Methods: A retrospective study of consecutive cases of NOPIR was performed at The University of Osaka Hospital in Japan. The clinical characteristics and treatment history of patients were reviewed. Results: In total, 13 eyes of 12 patients with NOPIR were included. At baseline, the mean (±SD) age was 65.8 ± 10.3 years, mean intraocular pressure was 14.9 ± 3.9 mm Hg, and mean refractive error was -2.12 ± 2.4 diopters. Two eyes had moderate glaucoma at baseline. Ten eyes (91%) did not have glaucoma at baseline; however, glaucoma developed later after the initial diagnosis. The mean time from baseline to glaucoma diagnosis was 31.6 ± 15.2 months. Of the 13 eyes, retinoschisis associated with NOPIR was treated with vitrectomy in 6 eyes and with observation in 7 eyes. The time to resolution of retinoschisis was shorter in the surgery group (mean ± SD 14.7 ± 7.6 months) than in the observation group (52.4 ± 21.4 months) (P = .005). The time to diagnosis of glaucoma was also shorter in the surgery group (9.5 ± 12.8 months) than in the observation group (35.6 ± 16.1 months) (P = .02). Conclusions: Eyes with NOPIR can have glaucoma present at the time of diagnosis, but it more commonly develops later thereafter. Screening for glaucoma and visual field testing should be considered in eyes with NOPIR.

Purpose: To report a case of myopic macular retinoschisis and full-thickness macular hole (FTMH) that both resolved with topical medical therapy alone. Methods: A retrospective chart review was performed. Results: A patient with myopic retinoschisis with an FTMH and increased symptoms of metamorphopsia was treated with topical medical therapy consisting of 1% prednisolone, 4 times daily, and 0.07% bromfenac, daily. Anatomic changes at 6 weeks included drawing together of the inner retinal edges around the MH and its subsequent closure with marked resolution of the myopic retinoschisis. Conclusions: Severe myopic macular retinoschisis and an FTMH both resolved with topical therapy consisting of steroidal and nonsteroidal anti-inflammatory medications. This rapid resolution contradicts current theories of the pathogenesis of myopic macular retinoschisis.

ABSTRACT Purpose To investigate the prevalence, associated factors, and inter-eye differences of myopia and astigmatism in an adult Japanese population-based cohort. Methods A total of 4282 participants from the Tohoku Medical Megabank Organization Eye Study (ToMMo Eye Study) underwent comprehensive ocular examinations as well as extensive physiological tests and a lifestyle questionnaire. The spherical equivalent (SE) and cylinder power were obtained as refractive parameters. The age- and gender-stratified prevalences of high myopia (SE < −5D), myopia (SE < −0.5D), hyperopia (SE > 0.5D), astigmatism (cylinder power < −0.5D), and anisometropia (SE difference >1D) were calculated. Multivariable analyses were performed to identify associated factors for refractive error (RE). Distribution and associated factors of the inter-eye difference in RE were also investigated. Results The age-adjusted prevalence of high myopia, myopia, hyperopia, astigmatism, and anisometropia was 15.9%, 63.5%, 14.7%, 51.1%, and 14.7%, respectively. Both myopia and high myopia were more prevalent in the younger age group, while astigmatism was more prevalent in the older age group. Age, education, blood pressure, intraocular pressure, and corneal thickness are significantly associated with myopic refraction. Age, gender, intraocular pressure, and corneal thickness are correlated with astigmatism. Older age was associated with against-the-rule astigmatism. Older age, myopia, and longer education showed a significant correlation with large inter-eye differences in SERE. Conclusions This study demonstrated the high prevalence of myopia in young Japanese, which may be caused by a generational shift. This study also confirmed the influence of age and education on both the prevalence and inter-eye differences of RE.

Purpose: The aim of the study was to evaluate the refractive outcomes of combined cataract surgery and vitrectomy compared to cataract surgery alone. Methods: This retrospective chart review study included two groups: (1) combined surgery in 103 eyes (101 patients) who underwent cataract surgery with posterior chamber intraocular lens (PCIOL) placement by a single cataract surgeon and vitrectomy by a single vitreoretinal surgeon at the same surgical setting; (2) cataract surgery alone by the same surgeon in 107 eyes (84 patients). Refractive outcomes and complications between the combined and cataract surgery alone group were compared. The predicted refractive error was compared to postoperative refractive outcomes in both groups, surgically induced astigmatism (SIA), intraoperative or postoperative complications of either cataract surgery or vitrectomy, and cystoid macular edema. Results: There was no statistically significant difference between predicted and actual postoperative refractive outcomes between the combined and cataract surgery alone groups (within ±0.5 diopters [D], p = 0.099; within ±1.0 D, p = 0.721). There was no difference in SIA refractive outcomes between the two groups (p = 0.509). The use of intraoperative gas for retina tamponade did not significantly affect postoperative refractive outcomes. Both cataract surgery and vitrectomy were successfully performed without unexpected complications from either procedure affecting the other. Discussion/Conclusion: Combined cataract surgery and vitrectomy allows excellent refractive outcomes equal to cataract surgery alone, allowing each procedure to be performed independently by separate anterior and posterior segment surgeons. Combined procedures can be performed in eyes with a variety of retinal indications and can include fluid-gas exchange with minimal risk of PCIOL malposition or change in targeted refraction.