Retinal detachments due to large-outer retinal tear in acquired retinoschisis managed with adjunctive combinations of microscope-integrated and wide-field optical coherence tomography.

Abstract

This case series includes three consecutive cases who presented with retinal detachment (RD) in acquired retinoschisis due to giant outer lamellar tears. Preoperative widefield optical coherence tomography (WF-OCT) was used for diagnosis and intra-operative optical coherence tomography (iOCT) was used to confirm the extent of retinoschisis, identify borders of retinectomy and identify a safe area for drainage retinotomy. All eyes developed recurrent RD and required repeat surgeries. Learnings from the immediate failure of the first case guided our surgical planning with iOCT-assisted surgery in the next two cases leading to acceptable outcomes. Fellow eye required WF-OCT guided prophylactic laser barrage in two out of three cases. We concluded that preoperative recognition of giant outer layer lamellar tears in retinoschisis is crucial as these cases harbor poor anatomical prognosis and demand patient counseling. We found WF-OCT and iOCT to be very useful in understanding and management of these eyes.