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This 39YO female has been followed by us for over 20 years with high myopia and lattice degeneration. At the last examination 6 months earlier, vision was 20/70 OD. She returned 6 months later with asymptomatic decreased vision in her right eye. Vision was counting fingers.
Optos color RG imaging shows a rhegmatogenous retinal detachment (RRD) extending from the macula into the midperiphery. Triton swept-source OCT confirms the causative macular hole. A partial PVD temporally extends and elevates the nasal edge of the hole, with complex elevated epiretinal membranes extending towards the nerve. The detached neurosensory retina is diffusely thickened with mostly outer nuclear layer cysts. The hole and detachment are best visualized with the green channel.
Three months following vitrectomy and subsequent cataract surgery, vision improved to 20/200. Although the retina was completely attached, the macular hole remained open clinically and on OCT. Our patient was functioning well and deferred further surgery.
Learning Points:
RRD with concurrent non-causal macular holes are uncommon, occurring in 2% of eyes (Iros et al, Retina 2023;43:581-584). Repair of the causative peripheral break(s) without addressing the MH nearly always repairs the detachment and the MH, although many will also perform internal limiting membrane peeling. We have seen several high myopes, including our current patient, with macular holes causing posterior RRD. Vitrectomy in these eyes also has a high surgical success rate, although persistent subretinal fluid may be more common (Cheng et al, Retina 2024;44:782-790).
J Vitreoretin Dis. 2026 Mar 11:24741264261427832. doi: 10.1177/24741264261427832
No optic pit retinoschisis can have glaucoma at baseline, but more commonly develops thereafter. Consider glaucoma screening at baseline for NOPIR patients — Retrospective, 13 eyes.
Purpose: Peripapillary and macular retinoschisis can occur without visible optic pits or advanced glaucomatous optic atrophy, a condition referred to as no optic pit retinoschisis (NOPIR). This study sought to further define the clinical features of NOPIR in a single-center case series.
Methods: A retrospective study of consecutive cases of NOPIR was performed at The University of Osaka Hospital in Japan. The clinical characteristics and treatment history of patients were reviewed.
Results: In total, 13 eyes of 12 patients with NOPIR were included. At baseline, the mean (±SD) age was 65.8 ± 10.3 years, mean intraocular pressure was 14.9 ± 3.9 mm Hg, and mean refractive error was -2.12 ± 2.4 diopters. Two eyes had moderate glaucoma at baseline. Ten eyes (91%) did not have glaucoma at baseline; however, glaucoma developed later after the initial diagnosis. The mean time from baseline to glaucoma diagnosis was 31.6 ± 15.2 months. Of the 13 eyes, retinoschisis associated with NOPIR was treated with vitrectomy in 6 eyes and with observation in 7 eyes. The time to resolution of retinoschisis was shorter in the surgery group (mean ± SD 14.7 ± 7.6 months) than in the observation group (52.4 ± 21.4 months) (P = .005). The time to diagnosis of glaucoma was also shorter in the surgery group (9.5 ± 12.8 months) than in the observation group (35.6 ± 16.1 months) (P = .02).
Conclusions: Eyes with NOPIR can have glaucoma present at the time of diagnosis, but it more commonly develops later thereafter. Screening for glaucoma and visual field testing should be considered in eyes with NOPIR.
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