Schwartz-Matsuo Syndrome (Grand Rounds)

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Original article contributed by: Jesse L. Berry, MD
All contributors: Jesse L. Berry, MD
Assigned editor:
Review: Assigned status Up to Date by Jesse L. Berry, MD on June 8, 2017.


Schwartz Title.jpg

History

  • 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
Schwartz 1.jpg

Differential Diagnosis

  • Schwartz-Matsuo syndrome
  • Angle recession glaucoma with traumatic retinal detachment
  • Pseudoexfoliation glaucoma
  • Pigmentary glaucoma
  • Posner-Schlossman syndrome (glaucomatocyclitic crisis)
  • Uveitic glaucoma

Additional Investigations

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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.
  • Davidorf FH. Retinal pigment epithelial glaucoma. Ophthalmol Dig. 1976;38:11-16.
  • 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.
  • Netland PA. Elevated intraocular pressure secondary to Rhegmatogenous Retinal Detachment. Surv Ophthalmol. 39:234-240.
  • Phelps CD, Burton TC. Glaucoma and retinal detachment. Arch Ophthalmol. 1977 Mar;95(3):418-422.

Contact

  • Alena Reznik, MD, Assistant Professor of Clinical Ophthalmology, alena.reznik@med.usc.edu
  • On-Tat Lee, MD, PGY-3 Ophthalmology resident, on-tat.lee@med.usc.edu