Fig. 7.40 XL retinoschisis has a very diaphanous inner layer. Occasionally, these patients develop retinal detachment as shown here with OCT confirming SRF (see Fig. 7.41)

7.8.2Surgery

This is a surgical challenge. The principle of closure of retinal breaks either outer leaf or the inner leaf applies. The inner breaks are usually only a few and small. If the RRD is shallow and the inner holes can be closed onto a scleral indent, then a non-drain approach can be used.

Note: The holes must be flat on the indent (unlike RRD) for non-drain repair to work (as far as we know!).

These inner breaks do not respond to retinopexy and are reliant upon the effect of the indent alone.

More commonly, the schisis is too elevated to buckle, and a PPV is required (Hoerauf et al. 2001; Aslan et al. 1998;

Detached retina

Fluid

Inner leaf break

Outer leaf breaks

Fig. 7.42 Retinoschisis retinal detachments occur when a communication occurs between the vitreous cavity and the subretinal space. This happens when an inner leaf break is present in conjunction with outer leaf breaks, allowing fluid to pass from the vitreous cavity to the subretinal space

Fig. 7.43 Apply laser around the outer leaf holes in schisis RRD

Fig. 7.44 The leading edge of a retinoschisis RD in which the SRF has come from the schisis cavity lifting the outer leaf breaks see Fig. 7.45. There are no inner leaf breaks so that fluid accumulation is very slow (see Fig. 7.46)

Fig. 7.45 See previous figure

Fig. 7.46 Laser to the edge of the outer leaf breaks was enough to cause flattening of the retinal detachment over 18 months

Fig. 7.48 A postoperative retinoschisis RRD in which the schisis was deroofed. The OCT of the fovea is seen 10 years after surgery with 20/60 vision

Fig. 7.47 The coloboma from deroofing of a retinoschisis RRD 10 years after the surgery