LAUSR

A 42-year-old man presented to his optometrist having experienced one month of blurred and distorted vision in the left eye, with no associated pain or redness. He had no significant medical or ocular history. His presenting visual acuity was R 6/4 L 6/24 pressures of R 16 mmHg L 13 mmHg. Pupils were equal and reactive to light and the patient reported central distortion on viewing of the Amsler grid with the left eye. Figure 1 shows a fundus photograph of the left eye at presentation (Optos Optomap). The macula appeared to have a central hole and the optic disc pit was visible as a round grey area at the temporal edge of the optic disc. A contemporaneous optical coherence tomography (OCT) scan (Cirrus HD-OCT, Carl Zeiss Meditec, Jena, Germany) (Figure 2) demonstrated multilayered retinoschisis, neurosensory detachment and an outer retinal hole. In accordance with descriptions offered by Imamura et al., Figure 2A illustrates fluid collection under the neurosensory detachment and within the outer nuclear layer, inner nuclear layer and ganglion cell layer. The fluid also extended beneath the internal limiting membrane (ILM), which can be seen in Figure 2B. One week after presentation and following informed consent, the patient underwent a left pars plana vitrectomy, posterior hyaloid face and ILM peel and gas exchange with 10 per cent perfluoropropane. To avoid damaging the papillomacular bundle, no laser was applied to the disc pit margin. Two months post-operatively, the vision had improved to 6/12. As shown in Figure 3A, the degree of schisis and subretinal fluid had reduced, although a full-thickness macular hole was evident with associated cystic changes. By five months (Figure 3B), the retina was flat, the macular hole had closed and vision was 6/6. Macular morphology (Figure 3C) and vision were stable at the 14-month follow-up.