PARS PLANA VITRECTOMY WITH FOVEAL CYST ASPIRATION AS A TREATMENT OPTION FOR MACULAR RETINOSCHISIS IN A COATS-LIKE RETINITIS PIGMENTOSA CASE.
Sengul Ozdek, Emrah Ozturk, Tugce Kucukbalcı et al.
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Case in brief
A 45-year-old woman with CRB1 mutation-related retinitis pigmentosa was referred for surgery for macular detachment. Examination and imaging showed bilateral bullous macular retinoschisis associated with Coats-like retinitis pigmentosa. Six anti-VEGF injections and two sessions of laser ablation of telangiectatic vessels in both eyes produced no response. Both eyes were then treated with pars plana vitrectomy, foveal cyst aspiration using a 41 G needle, endolaser to telangiectatic vessels, and sulfur hexafluoride tamponade. The authors reported anatomical and functional improvement.
What made this case unusual
The case combined bilateral bullous macular retinoschisis with CRB1-related, Coats-like retinitis pigmentosa; the cystic macular changes did not respond to anti-VEGF injections or laser before surgical microaspiration was performed.
Diagnostic / clinical pearl
In Coats-like retinitis pigmentosa, macular detachment may reflect bullous macular retinoschisis. Recognising this anatomy can inform consideration of cyst aspiration when anti-VEGF injections and laser have not produced a response.