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Vitreous leakage possible cause of macular schisis and detachment
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Fluid leaking from the vitreous may cause macular schisis and detachment in patients with pronounced optic nerve head cupping, a small study suggests. Performing a vitrectomy or taking other measures to reduce IOP may help resolve the fluid leakage and improve vision, the authors noted.
David S. Zumbro, MD, and colleagues at several U.S. centers reviewed records for five glaucoma patients with acquired optic nerve head cupping and macular schisis either with or without macular detachment. None of the five cases showed any "obvious" congenital disc anomalies. Also, all patients showed neither leakage on fluorescein angiography nor vitreous traction on optical coherence tomography exams, according to a study.
In one patient, the macular fluid resolved after undergoing filtering surgery for uncontrolled glaucoma. Another two patients had "almost total" resolution after undergoing vitrectomy with intraocular gas. These two patients also had an improvement in vision, the authors noted.
The authors believe that fluid leaking from the vitreous through a tiny hole in the cup's thin tissue caused the macular schisis and detachment. "This is a similar mechanism to that seen in patients with optic pits," they said.
"A vitrectomy or steps to reduce the intraocular pressure may result in resolution of the fluid and improved vision," they said.
The study is published in the July issue of American Journal of Ophthalmology.