to describe a patient with intrachoroidal cavitation in the normal eye that caused self - limiting recurrent macular detachment and retinoschisis .
an 80-year - old female patient with intrachoroidal cavitation in the normal eye presented with macular detachment and retinoschisis after cataract surgery .
one year after cataract surgery , the patient presented with macular detachment and retinoschisis in the same eye again .
this case suggests that similar cases of cystoid macular edema after cataract surgery can occur , and that intrachoroidal cavitation is observed not only in eyes with pathologic myopia but also in normal eyes with peripapillary atrophy ; intrachoroidal cavitation can cause macular detachment and retinoschisis .
macular detachment and retinoschisis are often associated with x - linked retinoschisis , pit - macular syndrome and coloboma [ 13 ] .
however , recent studies have reported other causes of macular detachment and retinoschisis [ 47 ] .
intrachoroidal cavitations are often observed in pathologic myopia , but not in normal eyes , and can result in retinoschisis and macular serous detachment [ 5 , 8 ] .
other studies have shown peripapillary retinoschisis in glaucomatous eyes [ 9 , 10 ] , which resolved without treatment in some cases . here ,
we present a patient with intrachoroidal cavitation in the normal eye , with peripapillary atrophy ( ppa ) , that caused self - limiting recurrent macular detachment and retinoschisis .
an 80-year - old woman presented with visual loss in her right eye to the sensho - kai eye institute . her best - corrected visual acuity measured 20/100 od and 20/16 os . in the right eye , a grade 2 nuclear cataract based on the emery scale was observed with an axial length of 23.80 mm and a refractive error of  1.0 diopters . the intraocular pressure measured 15 mm hg od and 14 mm hg os .
no significant changes were observed in other parts of her eyes except small temporal conus .
macular serous detachment and cysts were observed using rtvue-100 fourier - domain optical coherence tomography ( rtvue - oct ; optovue inc . ,
although rtvue - oct showed prominent serous detachment and cysts , fluorescent angiography showed slight pooling in the cystic space and no robust leakage comparable to configuration obtained by rtvue - oct ( fig .
the eye was treated as cystoid macular edema with intravitreal bevacizumab ( 1.25 mg ) 2 months after surgery .
the patient presented with decreased vision and central scotoma in her right eye to kyoto medical center .
rs-3000 spectral - domain oct examination ( sd - oct ; nidek co. ltd . , tokyo , japan ) showed macular detachment and retinoschisis extending to ppa ( fig .
intrachoroidal cavitations connecting to the cystic space were observed adjacent to the disc ( fig .
the connection between the intrachoroidal cavitation and cystic space appeared as breakage of elschnig 's collagenous limiting tissue , which connects the choroid to the optic disc .
since the patient refused further examinations , such as fluorescent angiography , sd - oct was used to monitor the condition monthly .
serous retinal detachment and retinoschisis gradually absorbed , and was almost fully absorbed 4 months after onset ( fig .
the left eye also showed intrachoroidal cavitation ; however , no incidence of retinoschisis or retinal detachment has been noted ( fig .
no coloboma or optic disc pit was observed on ophthalmoscopy , but some ppa was found in the patient 's eyes . in her right eye , a yellow - orange lesion was also found that was reported as peripapillary detachment in pathologic myopia ( fig .
2 g ) . the hyporeflective space observed with sd - oct suggested the presence of fluid was not in large blood vessels but in the space of the intrachoroidal cavitation because no corresponding large vessels were visible in the ppa- area .
the first incidence was resolved within 9 months with intravitreal bevacizumab , whereas the second incidence was resolved without treatment .
this is similar to irvine - gass syndrome that is characterized by cystoid macular edema following cataract surgery .
however , fluorescent angiography did not show the robust leakage associated with serous detachment and retinoschisis , suggesting another source of fluid like pit - macular syndrome could exist .
retinoschisis appeared to extend to the disc , unlike that observed in common cystoid macular edema .
recent studies have reported that peripapillary retinoschisis can be seen in glaucomatous eyes [ 9 , 10 ] and resolved without treatment . in our case , however , macular detachment and retinoschisis occurred immediately after cataract surgery , and may have therefore caused the fluctuation of intraocular pressure .
the period of self - resolution of the second incidence was even shorter than that of the first .
we have encouraged the patient to follow up periodically to assess any changes . although previous studies on peripapillary detachment in pathologic myopia showed small pit formation connecting the cystic space and vitreous , no such pit formation was observed in our case on thorough observation using sd - oct .
the subretinal fluid in other cases may have been derived from the vitreous ; however , the fluid in our case may have been derived from intrachoroidal cavitation or spinal fluid .
since there was no connection between vitreous and macular detachment , such a condition may facilitate self - resolution .
previous studies have reported intrachoroidal cavitation or peripapillary detachment in pathologic myopia but not in normal eyes [ 47 ] . here , we reported a case of intrachoroidal cavitation in an eye with normal length and having ppa , resulting in self - limited recurrent macular detachment and retinoschisis .
our case suggests that similar cases of cystoid macular edemas after cataract surgery exist , and that intrachoroidal cavitation is observed not only in pathologic myopia but also in normal eyes with ppa ; intrachoroidal cavitation can cause macular detachment and retinoschisis . in cases of cystoid edema following cataract surgery
, we should carefully observe not only the macular area but also the peripapillary area .
 purposeto describe a patient with intrachoroidal cavitation in the normal eye that caused self - limiting recurrent macular detachment and retinoschisis.case reportan 80-year - old female patient with intrachoroidal cavitation in the normal eye presented with macular detachment and retinoschisis after cataract surgery . 
 these were treated with intravitreal bevacizumab and then absorbed within 9 months . 
 one year after cataract surgery , the patient presented with macular detachment and retinoschisis in the same eye again . 
 these were absorbed within 4 months without treatment.conclusionthis case suggests that similar cases of cystoid macular edema after cataract surgery can occur , and that intrachoroidal cavitation is observed not only in eyes with pathologic myopia but also in normal eyes with peripapillary atrophy ; intrachoroidal cavitation can cause macular detachment and retinoschisis . 
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Case Report
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