EXTREME MACULAR SCHISIS–SIMULATING RETINAL DETACHMENT IN EYES WITH PATHOLOGIC MYOPIA

We report a new clinical entity termed extreme macular schisis simulating retinal detachment. They resemble a macula hole retinal detachment, but they differ by having thin remnants of the retina on the retinal pigment epithelium. All of the patients with extreme macular schisis simulating retinal detachment had a medical history of myopic macular neovascularization. Purpose: To determine the clinical and imaging characteristics, natural course, and surgical outcomes of pathologic myopic eyes with an extreme macular schisis simulating a retinal detachment (EMSSRD). Methods: The data of 617 highly myopic eyes with myopic traction maculopathy were studied. The diagnosis of EMSSRD in the optical coherence tomography images was made based on a high elevation of the retina (>500 µm), less obvious columnar structures, and the presence of thin remnants of outer retinal tissues above the retinal pigment epithelium. Results: Among 617 eyes, 25 eyes had an EMSSRD. All of the eyes with an EMSSRD had macular atrophy caused by myopic macular neovascularization. In the five eyes they had progressed to MHRD, the retinal detachment started away from the macular atrophy. Among the 10 eyes which required surgery, there was no significant difference in the presurgical and postsurgical best-corrected visual acuity between the eyes operated because of a worsening of the EMSSRD and the eyes operated because of a progression to MHRD. Conclusion: In severely myopic eyes with macular neovascularization–related macular atrophy, a novel condition termed EMSSRD can be present. The optical coherence tomography images resemble those of a MHRD except the presence of thin remnants of the retina remaining on the retinal pigment epithelium.