THE ROLE OF INNER WALL RETINECTOMY IN THE MANAGEMENT OF JUVENILE RETINOSCHISIS

Purpose: The purpose of this paper is to describe the technique and ap plication of relief of vitreous traction and inner wall retinectomy in the management of juvenile retinoschisis (JRS). In addition, during t he course of this study a previously undescribed form of tractional re tinal detachment associated with retinal schisis was observed. Methods : Six eyes of four children with visual field and/or central vision lo ss underwent vitrectomy (in five of the six eyes the lenses were prese rved), inner wall retinectomy and photocoagulation for rhegmatogenous/ schisis retinal detachment, tractional retinal detachment and reduced central vision secondary to intraschisis hemorrhage overhanging the ma cula. Results: The children were followed up for I to 4 years. All eye s showed anatomic reattachment. Three of the four eyes that could be t ested for vision showed improved visual function postoperatively. One eye showed marked enlargement of visual field and central visual acuit y improvement from 20/200 preoperatively to 20/50 postoperatively. Con clusion: Inner wall retinectomy can be a useful adjunct in the managem ent of the retinal complication of JRS. Appropriate case selection of eyes with associated central traction retinal detachment can result in improved visual field and central visual acuity. The success of this technique suggests that the mechanical and/or pharmacological relief o f vitreous traction may be able to alter the clinical course of JRS.