Outer layer breaks and asymptomatic schisis detachment: clinical considerations

To provide a detailed description of the clinical features that are considered forerunners of symptomatic complications in asymptomatic degenerative retinoschisis, and to show that in selected cases at this stage prophylactic photocoagulation may be a better choice than mere observation.

Forty-three eyes of 27 patients with asymptomatic bullous degenerative retinoschisis and outer layer breaks (OLBs) were studied through binocular indirect dynamic ophthalmoscopy and retinal biomicroscopy with the Goldmann 3-mirror lens, fundus drawings, and photographs where feasible. Argon laser treatment was performed on each eye: first, around the posterior border of the schisis to achieve a full-thickness retinal scar, and then on the schisis itself to promote scarring of the retinal pigment epithelium, thus avoiding retinal detachment. The follow up was 2 years minimum after treatment.

OLBs usually involved the largest schises when multiple retinal splittings were present. Breaks were single in 18 eyes (peripheral in 16 and posterior in 2) and multiple in 25 (peripheral in 15 and posterior in 10). Overall, 23 eyes showed asymptomatic retinal detachment (schisis detachment): 20 with peripheral outer layer breaks and 3 with posterior breaks. Schisis detachment was localized to the schisis area in the first group, whereas it extended beyond the posterior boundary of retinoschisis in the latter. After treatment, no posterior progression of retinoschisis was noted nor did symptomatic retinal detachment arise. Only 1 eye had complications in the second step of the treatment that was later resolved with medical care.

Prophylactic Argon laser photocoagulation can be used safely in the asymptomatic stage of bullous retinoschisis with outer layer breaks to avoid the onset of acute symptomatic retinal detachment.