Juvenile retinoschisis, anterior retinal dialysis, and retinal detachment.

Ringland Anderson (1932) coined the term "anterior retinal dialysis" to describe dehi- scence of the retina at the ora serrata, because of its resemblance to iridodialysis.As he and others (Shapland, I934, I949; Leffertstra, I950; Duke-Elder and Dobree, I967) have noted, this condition is the commonest cause of retinal detachment in young people.The dialysis results from trauma in about one-quarter of the cases; the nontraumatic cases have an uncertain aetiology.M\4any authors have emphasized the overwhelming predilection of these dialyses for the infero-temporal area of the fundus, especially where the dialysis is nontraumatic (Shapland, 1934, 73 per cent. of I I 3 cases; Shapland, I 948, go per cent. of 22 cases; Leffertstra, 1950, 83 per cent. of 200 cases).Bilaterality is another feature of the condition.Kornzweig (1940) cited Schmelzer (1936), who reported two brothers, aged 25 and 32 years, with bilateral lower-half retinal detachments and infero-temporal anterior retinal dialysis.Shapland (I948) had seen this in I938 in a 28-year-old man.Shapland (I949) remarked that 2 per cent. of any large series of dialysis might be bilateral.Levy (I 952) saw bilateral infero-temporal anterior retinal dialysis in a young man, with a related retinal detachment in one eye.Leffertstra (1950) found I4 per cent. of 200 cases to be bilateral; in 71 cases in which scleral depression was used during examination the proportion showing bilaterality was 20 per cent.Weve (1936) first suggested that nontraumatic dialysis might be due to antecedent cysts of the ora serrata.Shapland (i945) referred to "rupture of retinal cysts causing retinal detachments".Stallard (1946), reporting two cases of unusual upper temporal cystic detachments in young men, remarked that twelve of thirteen such cases, i.e. cystic detachments, seen in the Middle East Forces during the second world war, developed tears, seven multiple.In two cases the cystic detachment spread, causing macular detachment, and this experience prompted him to recomnmend prophylactic surgery in the two cases he reported.Others had noticed bilateral cystic detachments without tears (Ridley, 1935, I936; Kornzweig, 1940), some in older people but mostly in young men.Duke-Elder (I 949) reported a case of peripheral retinal cyst in a 44-year-old man leading to anterior retinal dialysis and retinal detachment.This followed a period of enlargement of the cyst.In his series of 200 cases of anterior retinal dialysis from WNeve's clinic, Leffertstra (1 950) found that 53 of 228 eyes showed retinal cysts in addition to their dialysis and retinal detachment.There were cases with multiple cysts and, in all, I05 cysts were counted.Leffertstra defined retinal cyst as "a greater or smaller, round or oval vesicle, of greater or