C A S E R E P O R T Peripapillary detachment in pathologic myopia: Unusual OCT ﬁndings Michele Carbonelli Giacomo Savini Maurizio Zanini Piero Barboni Centro Salus, Bologna, Italy Correspondence: Michele Carbonelli Centro Salus,Via Safﬁ 4/H, 40131 Bologna, Italy Tel +39 051 555311 Fax +39 051 524486 Email mcarbonelli@libero.it Purpose: To report an unusual case of myopic peripapillary retinal detachment (PPRD) imaged by optical coherence tomography (OCT). Methods: Observational case report. Results: OCT showed a nonreﬂective space between the retinal pigment epithelium and the neurosensory retina with the presence of bridging tissue that could be deﬁned as an outer retinal schisis, which is not typical of myopic PPRD. Conclusion: This case suggests that the spectrum of PPRD in pathological myopia may extend beyond that already described. Keywords: myopia, optical coherence tomography, peripapillary detachment Introduction Peripapillary retinal detachment (PPRD) can occur in a variety of diseases, including pathologic myopia, peripapillary choroidal neovascularization (idiopathic or secondary to other conditions such as age-related macular degeneration) and polypoidal choroidal vasculopathy. When associated with pathologic myopia, PPRD appears on fundus examination as a yellow-orange, well-deﬁned dome-shaped lesion, which usually lies inferior to the optic disc; the visual symptoms are minimal, although perimetric defects may be present in as many as 71% of cases, and the evolution seems slow (Freund et al 2003; Shimada et al 2006). Recently this condition has been imaged by optical coher- ence tomography (OCT), which disclosed a localized detachment of both the retinal pigment epithelium (RPE) and retina (Freund et al 2003; Shimada et al 2006). The aim of this study was to describe a case of PPRD which showed unusual features. Case report A 38-year-old man came to us complaining of a relative scotoma in the visual ﬁeld of his right eye. Best-corrected visual acuity was 20/25 OD (and 20/160 OS because of chorioretinal myopic atrophy). In the right eye the refractive error was –19 diopters and the axial length was 30.5 mm. On fundus examination and ﬂuorescein angiography (FA), a perifoveal retinal hemorrhage was evident. The disc was tilted and surrounded by a yellow-orange, slightly elevated lesion, consistent with a PPRD, which hampered the visualization of the underlying choroidal vessels. On the nasal side of the optic disc a pale yellow round lesion, suggestive of RPE and choriocapillar atrophy, was present. The patient at that time did not undergo OCT. During the following six months the hemorrhage and the visual complaint progressively disappeared. At fundus examination two years later, the peripapillary detachment was still evident, with no detectable enlargement (Figure 1). When OCT was performed, a nonreﬂective space could be detected between the RPE and the neurosensory retina all around the optic disc. Such a space revealed some bridging tissue (probably Muller’s cells), which led us to classify it as an outer retinal layer schisis (Figure 2). Clinical Ophthalmology 2007:1(3) 327–329 © 2007 Dove Medical Press Limited. All rights reserved 327