Traumatic Dissected Outer Nuclear Layer of the Retina and Spontaneous Resolution: OCT and mfERG Findings


Traumatic Dissected Outer Nuclear Layer of the Retina and Spontaneous Resolution OCT and mfERG Findings by E. Perez-Salvador Garcia, A. Sanchez Ramon, MV. Garcia-Gallardo Sanz, Spain



To describe spontaneous resolution of traumatic dissected outer nuclear layer (DOLN) of the retina and its improvement followed functionally by multifocal electrorretinogram (mfERG) and by Spectral Domain Optical Coherence Tomography (SD-OCT).

Case Report:

46 year-old non myopic woman presented with sudden visual acuity loss (VA) 20/200 in the left eye resulting from unilateral macular retinoschisis after traffic accident and 20/20 in the right eye. Relative afferent pupillary deffect was negative. Fundus ophthalmoscopic examination revealed thickening and yellow discoloration of the posterior pole, a small vitreous hemorrhage without peripheral retinal tear. Spectral Domain Optical Coherence Tomography (3D-OCT1000, Topcon) showed the macular retinoschisis and splitting of the layers of the macula, cystic disruption of the outer plexiform layer, disruption of the outer nuclear layer, and disruption of the external limiting membrane, ellipsoid zone in macula. The architecture of the inner retina was relatively preserved. OCT reveals wide space with vertical columns and splitting of the retina into a thinner outer layer (80 microns) and thicker inner layer (303 microns). The central foveal thickness was recorded as 618 micro ns. Multifocal electrorretinogram (Retiscan, Topcon) mapping stimulus array of 61 hexagons covering 24 degree area showed regions of alteration in P1/N1 amplitude/implicit times in the inner 3 rings. After 1 month, retinal thickness and microanatomic profile improved spontaneously and after 2 months normalized in the affected eye, with restoration of macular microanatomy confirmed by OCT and functional improvement in mfERG and corrected VA was 1.


SD-OCT findings indicate that vitreous traction is one of the main pathogenic mechanism for development of retinal splitting in the current case. This case also demostrated that intervention may not be required in some patients with traumatic retinoschisis and expectant behaviour can be followed initially as in traumatic macular holes. The retinoschisis can be followed functionally by mfERG and its anatomy by SD-OCT and could be useful tools to clarify the severity of the damage.



Eduardo Perez-Salvador Garcia
Burgos, Spain
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