PMC3334215_01
Macular schisis and detachment associated with presumed acquired optic nerve head cupping. (A) Right eye fundus photograph at presentation, showing tortuous veins and multiple retinal hemorrhages compatible with central retinal vein occlusion. (B) Left eye fundus photograph showing schisis and detachment in the macula of the left eye associated with an enlarged optic disc cup at presentation. (C) Left eye optic disc optical coherence tomography at the black line in B showing a communication between the enlarged optic disc cup and the macular retinoschisis and neurosensory detachment at presentation. (D) Right eye fluorescein angiography showing central retinal vein occlusion and Stargardt disease at presentation. (E) Left eye fluorescein angiography showing absence of leak and Stargardt disease at presentation. (F) Left eye optic disc optical coherence tomography at the black line in H, showing closure of the communication between the enlarged optic disc cup and macular retinoschisis six months after surgery. (G) Right eye fundus photograph showing evolution of central retinal vein occlusion six months after the surgery day. Macular edema improved after three-monthly intravitreal bevacizumab injections. (H) Left eye fundus photograph of the left eye showing improved schisis and detachment, optic disc pallor, and a subretinal fibrosis temporal to fovea corresponding with the retinotomy site, six months after surgery. (I) Left eye macular optical coherence tomography centered in the fovea (dotted line in H), obtained six months after surgery, showing an improvement in the subretinal and intraretinal fluid.
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Right eye funduscopy showed a central retinal vein occlusion, and a cup/disc ratio of 0.7 (Figure 1A). Left eye funduscopy showed a cup/disc ratio of 0.8 without any other abnormality in the optic nerve head, and a serous macular detachment (Figure 1B). Retinal fluorescein angiography showed a choroidal silence and signs of Stargardt disease in both eyes (Figure 1D and E). Left eye retinal fluorescein angiography failed to show any leakage (Figure 1E). Optic coherence tomography showed a macular detachment in her left eye communicating with an enlarged optic disc cup, with no evidence of vitreomacular traction (Figure 1C). H, and I). However, visual acuity decreased to hand motion in her left eye six months after surgery, and papillary atrophy developed in spite of good intraocular pressure control (all measures inferior to 17 mmHg) with latanoprost (Figure 1H).