55-year-old male presents with progressive peripheral vision loss in his left eye occurring over several years
Associated with persistent floaters and photopsia
History of distant ocular trauma. Patient was a high-school football player and sustained several concussions and was also punched in the eye as a teenager.
Exam Findings
VA: 20/15 // CF @ 4ft ph 20/300
RAPD OS
IOP 15, 42
SLE: Unremarkable OU except lightly pigmented debris in anterior chamber OS
Gonioscopy – OD: open to CB 360; OS: open to CB 360 without evidence of angle recession, peripheral anterior synechiae, NVA or increased pigmentation
Figure 1: Dilated fundoscopy reveals a healthy appearing right optic nerve with pink and sharp margins and a 0.3 cup-to-disc ratio. There is no saucerization, notching or other changes noted within the right optic nerve. However, the left optic nerve exhibits deep cupping with a 0.9 cup-to-disc ratio and mild peripapillary atrophy.
Differential Diagnosis
Schwartz-Matsuo syndrome
Angle recession glaucoma with traumatic retinal detachment
Figure 2: Subtle, shallow superior retinal detachment from 10 to 12 o’clock extending to the optic nerve. May have resulted from a small atrophic hole (subclinical) with extension of subretinal fluid to posterior pole.Figure 3: B-scan showing high reflective, low mobile membrane with optic nerve insertion in superonasal quadrant (from 7 to 2 o’clock), low lying, consistent with retinal detachment.
Diagnosis
Schwartz-Matsuo syndrome
Pathophysiology
Rhegmatogenous retinal detachment (RRD) is frequently associated with reduced IOP thought to be from a decrease in aqueous production or an increase in aqueous outflow. In long-standing RRDs, photoreceptor outer segments may be released in sufficient quantities to obstruct aqueous outflow at the trabecular meshwork causing elevation of IOP. Retina reattachment surgery can normalize the high IOP.
Treatment
Treatment goals should focus on repair of the retinal detachment and expeditious IOP control
Prognosis and Future Directions
After successful retinal detachment repair, the anterior chamber cellular debris often disappears and IOP tends to normalize
Visual potential often depends on early diagnosis and treatment. Glaucoma may be so prominent that the underlying treatable cause of retinal detachment may be overlooked.
References
Schwartz A. Chronic open-angle glaucoma secondary to rhegmatogenous retinal detachment. Am J Ophthalmol. 1973;75:205-211.
Matsuo T. Photoreceptor outer segments in aqueous humor: key to understanding a new syndrome. Surv Ophthalmol. 1994;39:211-233.
Kooner KS, Zimmerman TJ. Differential diagnosis of unilateral glaucoma: Part I: Definition and classification. Ann Ophthalmol. 1983 Aug;15(8):695-7.
Chen X, Richter GM, Caprioli J, McCannel TA. Macular Microcysts in Schwartz-Matsuo Syndrome. Retin Cases Brief Rep. 2016 Dec 20.
Matsuo T, et al. Schwartz-Matsuo Syndrome in Retinal Detachment with Tears of the Nonpigmented Epithelium of the Ciliary Body. Acta Ophthalmol Scand. 1998:76(4);481-485.
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