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OCT scans show paravascular abnormalities may cause a macular retinoschisis in highly myopic eyes

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Serial optical coherence tomography scans demonstrate that paravascular lamellar holes appear to form when the inner wall of paravascular retinal cysts is avulsed by vitreous traction. These paravascular abnormalities are relatively common in eyes with high degrees of myopia, a study by researchers in Japan suggests.

"The presence of paravascular lamellar holes might enhance the proliferative response of the [internal limiting membrane], and this might be an important causative factor for the development of a macular retinoschisis in highly myopic eyes," the study authors said.

Noriaki Shimada, MD, and colleagues at Tokyo Medical and Dental University obtained stereoscopic fundus and OCT measurements for 287 eyes of 149 patients with high myopia and compared them with results obtained for a control group of 56 emmetropic eyes and 44 eyes with low myopia. For each patient, at least 30 OCT scans were made along the full extent of the posterior vascular arcade and across the fovea to examine the incidence of paravascular retinal cysts, vascular microfolds and paravascular retinal holes. The investigators also evaluated retinoschisis at the retinal vessels and macular retinoschisis.

Among the 287 eyes with high myopia, the investigators detected paravascular retinal cysts in 142 eyes (49.5%), vascular microfolds in 128 eyes (44.6%) and paravascular retinal holes in 77 eyes (26.8%) by OCT.

The paravascular retinal holes were partial-thickness lamellar holes in all of the patients; no full-thickness holes were detected, according to the study.

All vascular microfolds and paravascular lamellar holes were accompanied by paravascular retinal cysts, the authors noted.

OCT examinations showed the presence of vitreoretinal traction on the inner walls of retinal cysts in sections adjacent to the retinal holes.

Of the 77 eyes with paravascular lamellar holes, 34 eyes (44.2%) had internal limiting membrane detachments and 15 eyes (19.5%) had a macular retinoschisis.

Overall, 15 of 18 eyes (83.3%) with a macular retinoschisis had paravascular lamellar holes. However, no eyes in the control group had these paravascular abnormalities, according to the study, published in the April issue of Ophthalmology.