Macular schisis and detachment associated with presumed acquired enlarged optic nerve head cups.

PURPOSE: To describe a clinical syndrome of macular schisis and detachment in patients with acquired optic nerve head cupping resulting from glaucoma. DESIGN: Retrospective review of five patients. METHODS: Patients were included if they had optic nerve cupping and macular schisis with or without detachment with no other identifiable cause. The patients had to have no leakage on fluorescein angiography and no vitreous traction on examination or on optic coherence tomography (OCT). These patients were followed up and visual acuity, intraocular pressure, and the findings of serial fundus and OCT examinations were noted. RESULTS: Five patients had schisis with or without detachment of the macula with pronounced optic nerve head cupping. One patient had resolution of the macular fluid after filtering surgery for uncontrolled glaucoma. Two patients underwent a vitrectomy with intraocular gas and had almost total resolution of macular fluid and improved vision. CONCLUSIONS: Macular schisis and detachment can occur in patients with presumed enlarged optic nerve head cups in the absence of obvious congenital anomalies of the disk. The authors believe the cause is leakage of fluid from the vitreous through a tiny hole in the thin tissue of the cup. This is a similar mechanism to that seen in patients with optic pits. A vitrectomy or steps to reduce the intraocular pressure may result in resolution of the fluid and improved vision.

Purtscher-like retinopathy and primary hypereosinophilic syndrome association.

PURPOSE: The purpose of this study was to describe a patient who presented with a Purtscherlike retinopathy and subsequent diagnosis of primary hypereosinophilic syndrome. METHODS: Observational case report. PATIENT: A 39-year-old woman presented with a 10-day history of blurry vision and urticarial skin rash. Retinoscopic examination demonstrated bilateral cotton wool spots in the posterior pole, Purtscher flecken, and intraretinal hemorrhages. Workup included a complete history and systemic physical examination, fluorescein angiography, serum laboratory evaluation, magnetic resonance imaging of brain and orbits, pathologic analysis of skin and bone marrow biopsies, flow cytometry, and cytogenetic testing. RESULTS: The diagnosis given to this patient was primary hypereosinophilic syndrome. Review of the literature reveals one previous report of this association. CONCLUSION: The differential diagnosis of Purtscher retinopathy should include hypereosinophilic syndrome.