PMC3656919_01
Photographs of the left eye before pars plana vitrectomy (A-D) and during surgery (E). (A) Humphrey threshold 30-2 perimetry was performed at another hospital, and the images from that procedure show decreased sensitivity in the Bjerrum's areas. (B and C) Fundus photographs demonstrating retinal elevation with folds at the macula and optic nerve head cupping with nerve fiber layer defects (arrows) but no obvious optic disc pit. (D) Optical coherence tomography image showing retinal schisis extending from the optic disc to the macula, without retinal detachment, as well as membrane tissue with a sheet-like shape (white arrow) on the optic disc and a tunnel-like hyporeflective lesion (black arrow) directly connecting the retinal schisis and the 4 o'clock margin of the disc. (E) The membrane tissue on the optic disc grasped by forceps.
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Humphrey threshold 30-2 perimetry showed decreased sensitivity in the Bjerrum areas, with a mean deviation value of -3.40 dB in his left eye (Figure 1A). He had well-controlled diabetes mellitus treated by diet alone, and no significant medical family history. Funduscopic examination revealed retinal elevation with folds at the macula but no abnormal findings relating to the periphery OS (Figure 1B). The optic nerve head was large (the disc-to-macula distance to disc diameter ratio was 2.19) and had a 0.9 cup with nerve fiber layer defects (Figure 1B, arrows) but no obvious pit OS (Figure 1B and C). Spectral domain OCT showed retinal schisis extending from the optic disc to the macula OS but no retinal detachment (Figure 1D). Membrane tissue with a sheet-like appearance on the optic nerve head (Figure 1D, white arrow) and a tunnel-like hyporeflective lesion directly connecting the schisis cavity and the 4 o'clock margin of the disc (Figure 1D, black arrow) were observed. Internal limiting membrane in an area extending from the optic disc to the macula and the membrane tissue on the optic nerve head (Figure 1E, arrow) were removed.
Photographs of the left eye after vitrectomy. (A) Optical coherence tomography (OCT) image showing that the tunnel-like lesion in the optic disc was obscured 1 month after surgery and (B) retinal schisis was reduced 6 months after surgery. (C) Twelve months after surgery, OCT revealed that the tunnel-like hyporeflective lesion (black arrow) had resolved and retinal schisis had decreased further. (D) Fundus photograph taken 18 months after surgery showing the decrease in retinal elevation at the macula and no optic disc pit. (E) OCT image showing normalization of central retinal thickness with almost complete resolution of retinal schisis.. Abbreviation: M, month/s.
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The tunnel-like hyporeflective lesion on OCT was obscured from the early postoperative stage (Figure 2A and B). Twelve months after the operation, the retinal schisis was observed to have gradually reduced, and the tunnel-like lesion had completely resolved (Figure 2C, arrow), although the mean deviation value on Humphrey perimetry had worsened to -4.70 dB. Eighteen months after surgery, the patient's vision was found to have improved to 0.9 and the retinal schisis to have almost completely resolved (Figure 2D and E).