Abstract: Objective To investigate the clinical characteristics of retinal honeycomb appearance in patients with X-linked retinoschisis. Design Retrospective case series. Participants 43 patients (85 eyes) diagnosed as X-linked retinoschisis in Beijing Tongren Hospital from December, 2017 to January, 2020 were included. Methods Ultra-wide-field fundus imaging and examination note were used to review and analyze the clinical characteristics of retinal honeycomb appearance. Main Outcome Measures Morphology, location, incidence of the retinal honeycomb appearance and its association with visual acuity, other peripheral fundus changes and complications. Results The retinal honeycomb appearance was found in 20 cases (46.5%), 31 eyes (36.5%). Of which, 9 cases (45%) were monocular and 11 cases (55%) were binocular. There was no statistical difference of the age at diagnosis between groups with or without honeycomb appearance. There was a definite predilection for the superior temporal quadrant (28 eyes, 90.3%), followed by the inferior temporal (16 eyes, 51.6%), the inferior nasal (5 eyes, 16.1%) and the superior nasal quadrant (4 eyes, 12.9%). The best corrected visual acuity（logMAR） of eyes with honeycomb appearance were significantly lower than eyes without honeycomb appearance (0.82±0.14 VS 0.55±0.09, t=2.153, P=0.035). The honeycomb appearance was significantly associated with both peripheral retinoschisis and outer retinal hole (r=0.377, P=0.000; r=0.278, P=0.08). Eyes with honeycomb appearance had a higher rate of inner retinal hole, vitreous hemorrhage and retinal detachment than eyes without the honeycomb appearance（74.2% VS 59.3%; 32.3% VS 20.4%; 32.3% VS22.2%）, but did not reach statistical significance. Conclusions Retinal honeycomb appearance could be found in at least 1/3 of the patients with X-linked retinoschisis. Eyes with honeycomb appearance had worse BCVA and higher rate of inner retinal holes and complications like vitreous hemorrhage and retinal detachment. (Ophthalmol CHN, 2020, 29: 267-272)

Key words: retinoschisis/congenital, diagnostic imaging, retina