Pars Plana Vitrectomy in Progressive Stellate Non-Hereditary Idiopathic Foveomacular Retinoschisis (SNIFR): Surgical Outcomes and Considerations for Pathophysiology

Background To report the clinical course and outcomes of a surgical approach for progressive stellate non-hereditary idiopathic foveomacular retinoschisis (SNIFR) using pars plana vitrectomy (PPV). Methods Multi-center, consecutive, interventional case series. Patients with a diagnosis of SNIFR presenting with progressive loss of vision between January 1, 2017 and January 1, 2023. Evaluation of ophthalmologic findings and multimodal ocular imaging at the time of diagnosis, surgical procedure, and of visual and anatomic outcomes postoperatively. The main outcome measures evaluated include best corrected visual acuity (BCVA), central macular thickness (CMT), and findings on optical coherence tomography (OCT). Results Seven patients diagnosed with SNIFR were included. Median age in years at the time of diagnosis was 64 (range, 46–77). Four patients were female, and three were male. Genetic testing for mutations in retinoschisin 1 (RS1) and for other inherited conditions associated with foveomacular retinoschisis was negative. All patients demonstrated progressive retinoschisis, as well as worsening vision loss and metamorphopsia when managed conservatively. PPV was performed and revealed anomalously broad and dense adherence of the posterior hyaloid in all eyes. The internal limiting membrane (ILM) was peeled in all but one case. All eyes demonstrated postoperative resolution of retinoschisis and subretinal fluid, with corresponding improvements in both BCVA and subjective central visual distortion up to six months after surgery. Conclusion PPV is an effective surgical intervention resulting in anatomic resolution of retinoschisis and improved functional vision in eyes with progressive SNIFR.