Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

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Retina

Case 34

Patient Presentation: A 59-year-old male presented for a routine 6-month follow-up with his retinal surgeon for assessment of his epiretinal membrane. Vision is 20/25 OD and 20/40 OS. His OS OCT macula is shown below:

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Question: What abnormality is NOT visualized in the patient’s OCT image?

A. Epiretinal membrane

B. Sub-retinal fluid

C. Outer retinoschisis

D. Vitreomacular traction

Question: What is the diagnosis?

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Retinoschisis involving the macula can be difficult to differentiate from cystoid macular edema. On OCT, retinoschisis changes resemble intraretinal pseudo-cystic spaces exhibiting "strand-like" separations (or vertical pillars) as opposed to the oval or circular shaped intra-retinal fluid in CME. To definitively differentiate these two entities, an IVFA can be performed. There will be no leakage seen on IVFA in retinoschisis.

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Learning Objectives:

1. Understand the relationship and association of epiretinal membrane with VMT

2. Recognize retinoschisis as a complication of VMT