Membrane tissue on the optic disc may cause macular schisis associated with a glaucomatous optic disc without optic disc pits

Abstract

Saori Takashina,1 Wataru Saito,1 Kousuke Noda,1 Maki Katai,2 Susumu Ishida11Department of Ophthalmology, Hokkaido University Graduate School of Medicine, 2Ophthalmology, Sapporo Teishin Hospital, Sapporo, JapanAbstract: This article reports a case of possible involvement of membrane tissue on the optic disc with macular schisis formation associated with glaucomatous optic disc without optic disc pits. A 78-year-old man presented with loss of central visual acuity of the left eye. He had a medical history of primary open-angle glaucoma. Visual acuity was 0.6 in his left eye, and funduscopy revealed macular schisis and a glaucomatous optic disc without optic disc pits. Optical coherence tomography (OCT) revealed membrane tissue on the optic disc and a tunnel-like hyporeflective lesion connecting the schisis cavity and a site near the tissue, but no obvious optic disc pit. He underwent pars plana vitrectomy during which the membrane tissue on the disc and internal limiting membrane were removed. Posterior vitreous detachment was observed intraoperatively. Thereafter, the tunnel-like lesion observed on OCT was rapidly obscured and the macular schisis gradually reduced. Eighteen months after surgery, his visual acuity had improved to 0.9 with almost complete regression of the macular schisis. No optic disc pit was visualized after surgery. The changes in OCT findings described here suggest an etiology for macular schisis without optic disc pits in an eye with a glaucomatous optic disc with posterior vitreous detachment. A connection between the schisis cavity and the vitreous cavity may have appeared via the tunnel-like structure due to the membrane tissue exerting traction on the optic disc.Keywords: optical coherence tomography, pars plana vitrectomy, retinal schisis, glaucoma, optic disc pit maculopathy