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    General

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    Grand Rounds

    A child with no known medical or ocular history presented for evaluation of possible vision loss. Examination was limited due to poor cooperation, but loss of the red reflex and failure to fix and follow with the left eye raised concern for a vitreous hemorrhage. Examination under anesthesia revealed dense vitreous hemorrhage with pre-retinal membranes in the left eye, while the right eye had a normal-appearing fundus. B-scan ultrasonography of the left eye demonstrated peripheral schisis-like cavities, corresponding to areas of nonperfusion on fluorescein angiography. The right eye fluorescein angiogram was normal. Optical coherence tomography of the right eye revealed foveal schisis, aiding in the diagnosis of X-linked retinoschisis. Given these findings, an intravitreal bevacizumab injection was administered in the left eye. This case highlights the importance of recognizing a diminished red reflex as an early diagnostic clue to underlying vitreoretinal pathology in pediatric patients, leading to timely intervention and a molecular diagnosis of XLRS.

    Presentation Date: 07/24/2025
    Issue Date: 01/23/2026

    • Presenter: Charles Zhang, MD URL
    • Faculty Discussant: Audina M. Berrocal, MD URL

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