DOCSLIB.ORG

Japanese Journal of Ophthalmology Vol.41 No.5

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Japanese Journal of Ophthalmology Vol.41 No.5 ELSEVIER Abnormal Vitreous Structure in Optic Nerve Pit Tomoki Hasegawa, Jun Akiba, Satoshi Ishiko, Taiichi Hikichi, Akihiro Kakehashi, Hiroyuki Hirokawa and Akitoshi Yoshida Department of Ophthalmology, Asahikawa Medical College, Asahikawa, Japan Abstract: A 37-year-old man presented with an optic nerve pit and serous macular detach- ment of the left eye. Scanning laser ophthalmoscopy revealed a cyst-like structure terminat- ing at the pit in the premacular vitreous. During ocular movement, this structure moved vig- orously and seemed to exert traction on the pit. We believe that it is part of an anomalous Cloquet’s canal, and that traction on the pit may be a significant factor in the development of serous macular detachment in this patient. Jpn J Ophtbalmol 1997;41:32&327 0 1997 Japanese Ophthalmological Society Key Words: Cloquet’s canal, optic nerve pit, scanning laser ophthalmoscope, serous macu- lar detachment, vitreous. Introduction ular detachment in this patient. This case has been included in previously published reports on SLO An optic nerve pit is a rare congenital anomaly images.8,g that occurs in approximately 1 in 10 000 eyes.’ In early adulthood, half of the patients with this condi- tion develop a serous macular detachment;2,3 the mechanism of this development is not yet clear. Al- Case Report though several theories on the origin of subretinal A 37-year-old man visited our ophthalmology de- fluid have been proposed, the currently favored un- partment on February 15,1996 with blurred vision in derstanding is that fluid from the vitreous leaks the left eye. Initial examination found best-corrected through the optic pit, filling the subretinal space.’ visual acuities of 1.0 OD and 0.2 OS. Biomicroscopic The recently developed scanning laser ophthalmo- examination was normal; the intraocular pressure scope (SLO) allows observation of several layers of was within the normal range bilaterally. In the left the retina and the choroid at different depths.4-6 In eye, indirect ophthalmoscopy revealed a 2.5 disc di- addition, the real-time continuous imaging of the ameter serous macular detachment surrounded by a SLO is useful for observation of the dynamics of the 4.5 disc diameter retinoschisisl” (Figure 1). A macu- vitreous body.7-9 lar lamellar hole was also noted, and a gray pit was This article describes one case of optic nerve pit present in the inferotemporal quadrant of the optic associated with serous macular detachment. A cyst- disc (Figure 2). Biomicroscopic vitreous examination like structure in the vitreous cavity, presumed to be found that the posterior cortical vitreous was at- an anomalous Cloquet’s canal, was noted with the tached to the retina throughout the posterior pole to SLO. We believe this structure may have been a sig- the periphery, and an anomalous Cloquet’s canal nificant factor in the development of the serous mac- terminated at the pit. There was no traction on the macula noted. Fluorescein angiography showed only faint hyper- fluorescence because of a window defect in the mac- Received: September 27,1996 ular lamellar hole. There was no dye leakage into the Address correspondence and reprint requests to: Tomoki HA- SEGAWA, MD, Department of Ophthalmology, Asahikawa pit or retinal detachment on either fluorescein or in- Medical College, 4-5 Nishikagura, Asahikawa 078, Japan docyanine-green angiography. Jpn J Ophthalmol41,324-327 (1997) 0 1997 Japanese Ophthalmological Society 0021-5155/97/$17.00 Published by Elsevier Science Inc. PI1 SOO21-5155(97)00057-9 T. HASEGAWA ET AL. 325 ABNORMAL VITREOUS IN OPTIC NERVE PIT Figure 3. Scanning laser ophthalmoscopy image using ar- gon-green laser. Band-like hyporeflective area (arrows) Figure 1. Fundus photograph: left eye. Serous macular de- believed to be nerve fiber defect is clearly observed. tachment and surrounding reflection believed to be reti- noschisis are seen. the development of the detachment in this patient, a vitreous procedure was done on March 1, 1996. Af- Monochromatic fundus photography with a red- ter a core vitrectomy, a posterior vitreous detachment free filter showed a thin nerve fiber layer between was created and a fluid-gas (SF,) exchange was done. the optic nerve disc and the macula that appeared to The adhesion of the anomalous Cloquet’s canal to be a congenital nerve fiber defect. Using the SLO the edge of the optic nerve pit was easily released, with an argon-green laser, this thin nerve fiber layer suggesting that it was a weak adhesion. During the was identified as a band-like hyporeflective zone of procedure, we found no cyst-like structure in the nerve fiber (Figure 3). anomalous Cloquet’s canal. The retina reattached Scanning laser ophthalmoscope examination with postoperatively and the macular lamellar hole re- an argon-blue laser, reportedly useful in vitreous ob- solved. Visual acuity in the left eye had improved to servation,7-9 showed a cyst-like structure in the 1.0 at 3 weeks postoperatively. premacular vitreous with a slender connection to the pit (Figure 4). During ocular movement, this struc- ture moved vigorously and seemed to exert traction Discussion on the pit. The first description of optic nerve pit as a dark The diagnosis was optic nerve pit associated with gray hole in the optic disc appeared in 1882.” In serous macular detachment. Because we believed 1958, optic nerve pit was reported as frequently asso- that the cyst-like structure in the vitreous influenced ciated with central serous chorioretinopathy.12 Later, Figure 4. Scanning laser ophthalmoscopy image using ar- gon-blue laser. Cyst-like structure in premacular vitreous Figure 2. Fundus photograph: left eye. Pit (arrow) can be (arrows), with a slender connection to pit, moved vigor- seen at inferotemporal optic disc. ously during ocular movement. 326 Jpn J Ophthalmol Vol41: 324-321,1997 two-thirds of the optic nerve pit cases were found to detachment, we found none of the centripetal vitre- be associated with serous macular detachment13 and ous traction believed responsible for inducing serous this relationship, which is now widely recognized, macular detachment in the retinoschisis area, indi- was emphasized. cating that it may develop independently. The mechanism responsible for the development Visual field defects secondary to this disorder are of macular detachment in optic pit patients is not well recognized. 1,2~13Excluding enlarged blind spots clear. The subretinal fluid may originate from disc due to large optic discs and central scotomas second- capillaries, choroidal vessels, cerebrospinal fluid, or ary to serous macular detachment and retinoschisis, the vitreous.2,3*14-18The most widely accepted theory the most commonly encountered visual field defect at this time is that the liquified vitreous passes is arcuate scotoma.4-6 In the present case, a nerve fi- through the optic pit into the subretinal space.l In ber defect was clearly revealed by a SLO, and perim- the present case, because there was no dye leakage etry identified an arcuate scotoma corresponding to within the area of the detachment with either fluo- the nerve fiber defect area. rescein or indocyanine-green angiography, the sub- Because this is a report of a single case, further retinal fluid is believed to originate in the vitreous, study is required to substantiate our theory that the not in the disc capillaries or the choroidal vessels. serous macular detachment associated with optic The SLO permitted observation of the cyst in the disc pit may result from vitreous traction from an premacular vitreous linked to the pit by a strand-like anomalous Cloquet’s canal. connection. We believe this feature has not been re- ported previously. However, an anomalous Clo- quet’s canal connected to the optic pit has often References been observed by slit-lamp biomicroscopy.lg 1. Sadum AA. Optic disc pits and associated serous macular de- tachment. In: Ryan SJ, ed. Retina. 2nd ed. St. Louis: CV Because the optic pit derives from an incomplete Mosby, 19941829-35. closure of the embryonic fissure,1,20,21there also may 2. Brown GC, Shields JA, Goldberg RE. Congenital pits of the be a congenital abnormality of the vitreous and the optic nerve head: II. Clinical studies in humans. Ophthalmol- optic disc,19 leading us to speculate that the cyst seen ogy 1980;87:51-65. with the SLO was part of an anomalous Cloquet’s 3. Gordon R, Chatfield RK. Pits in the optic disc associated with macular degeneration. Br J Ophthalmol1969;53:481-9. canal. Observation of a Cloquet’s canal by slit-lamp 4. Sutoh N, Tanaka T, Sakamoto M. Observation of the ocular biomicroscopy is difficult, requiring ocular motion fundus with scanning laser ophthalmoscope. Rinsho Ganka for vitreous gel displacement?2T23 A normal eye will (Jpn J Clin Ophthalmol) 1992;46:763-70. have a Cloquet’s canal inserted around the optic 5. Tanaka T, Sutoh N. Scanning laser ophthalmoscope. Ophthal- disc,22J3 but our patient had an apparently abnormal mology (Tokyo) 1992,34:1449-59. canal with a wall of condensed plicated membranes, 6. Tokui K, Tanaka T. Scanning laser ophthalmoscope. Rinsho Ganka (Jpn J Clin Ophthalmol) 1993;47:1223-30. which were easily identifiable around the optic nerve 7. Kakehashi A, Ishiko S, Konno S, Akiba J, Kado M, Yoshida A. pit even on biomicroscopic observation without ocu- Observing the posterior vitreous by means of the scanning la- lar movement. ser ophthalmoscope. Arch Ophthalmol1995;113:558-6O. The premacular cyst was also noted to move in the 8. Kakehashi A, Ishiko S, Konno S, Kado M, Akiba J, Yoshida A. vitreous during ocular movement and seemed to Vitreous videography with a scanning laser ophthalmoscope. J Jpn Ophthalmol Sot 1995;99:819-23. cause traction on the pit via the connection we de- 9.
Load more

Recommended publications
  • Gas Tamponade Combined with Laser Photocoagulation Therapy
    Eye (2015) 29, 106–114 & 2015 Macmillan Publishers Limited All rights reserved 0950-222X/15 www.nature.com/eye 1,4 1,4 1,4 1 1 2 CLINICAL STUDY Gas tamponade L Lei ,TLi , X Ding ,WMa, X Zhu , A Atik , YHu1 and S Tang1,3 combined with laser photocoagulation therapy for congenital optic disc pit maculopathy Abstract Purpose To evaluate the long-term clinical Introduction efficacy and safety of gas tamponade Optic disc pit (ODP) is part of a spectrum of combined with laser photocoagulation for congenital cavitary optic disc anomalies which optic disc pit maculopathy. was seen in o1/11 000 patients.1 The pit lesions Methods Seven consecutive patients with are typically unilateral, oval, and gray-white unilateral maculopathy associated with 1State Key Laboratory of depressions located in the temporal segment of optic disc pit and one patient with bilateral Ophthalmology, Zhongshan the optic disc and frequently involve the macula Ophthalmic Center, Sun Yat- optic disc pit maculopathy were given via intra-retinal and sub-retinal fluid collections.2 sen University, Guangzhou, octafluoropropane (C3F8) tamponade Visual acuity and visual fields are normal unless China combined with focal laser photocoagulation associated with serous macular detachment. treatment. Patients were followed up for 2Royal Victorian Eye and Ear The mechanisms underlying this disease are 21–62 months after treatment. Main Hospital, Melbourne, VIC, unclear, especially in relation to intra-retinal Australia outcomes were determined by optical coherence tomography (OCT) and best- and sub-retinal fluid accumulation. ODP maculopathy (ODPM) was first described by 3Aier School of corrected visual acuity (BCVA).
    [Show full text]
  • Optic Nerve on Sheath：
    3/16/2018 < Optic nerve axons of retinal ganglion cells 1.2 million nerve fibers . ON sheath： continuous with the meninges dura、arachnoid and pia mater 1 3/16/2018 optic nerve functions 1.Visual Acuity 2.Color Vision 3.Pupil 4.Contrast sensitivity Ancillary Tests 1.Visual Field 2.Neuro-imaging 3.OCT 4.VEP Etiology：Optic nerve diseases 1.inflammation：optic neuritis 2 . ischemic optic neuropathy 3-Compression 4-Granuloma & infiltration 5-Hereditary 6-Toxic 7-Irradiation 8- Trauma . 2 3/16/2018 Optic Neuritis 3-Neuroretinitis 1-Retrobulbar neuritis 2-Papillitis Papillitis optic disc is normal hyperemia and edema with macular star . in adults common in children. least common type with multiple sclerosis. viral infections Rapid unilateral loss of vision RAPD Loss of color vision Pain in moving the eye Swollen disc with or without peripapillary flame-shaped hemorrhages. 3 3/16/2018 Fig optic neuritis Centrocecal scotoma Bilateral optic neuritis Bilateral Central scotoma 4 3/16/2018 Bilateral hemianopsia MRI demyelinating lesions multiple sclerosis Neuromylitis Optica VF showed non- central scotoma altitudinal VF an ischemic mechanism play a role in ON in NMO patients 5 3/16/2018 Optic Neuritis Follow Up Diffuse and central loss in the affected eye at baseline Follow Up : nerve fiber bundle defects were the predominant localized abnormalities in both the affected and fellow eyes physicians evaluate the characteristics of optic neuritis and other optic neuropathies in the future Ischemic optic neuropathy ( ION) 6 3/16/2018 Anterior ischemic optic neuropathy ( AION ) Arteritic Non- Arteritic GCA - vasculitis hypoperfusion of ONH transient visual loss, temporal sudden painless loss of vision pain, jaw pain, fatigue, weight loss hyperemic disc Pale disc Sectorial, diffuse edema optic disc edema splinter hemorrhages of a chalky white color Subsequent optic atrophy Nonarteritic ischemic optic neuropathy visual field altitudinal field defect 7 3/16/2018 NAION sudden, painless visual loss OS shows AION .
    [Show full text]
  • Resolution Ofan External Layer Macular Hole Associated with An
    BritishJournal ofOphthalmology 1993; 77: 457-459 457 Resolution of an external layer macular hole associated with an optic nerve pit after laser Br J Ophthalmol: first published as 10.1136/bjo.77.7.457 on 1 July 1993. Downloaded from photocoagulation Philip M Falcone, Peter L Lou Optic nerve pits are estimated to occur in 1 in 11000 patients.'2 Maculopathy associated with optic nerve pits occurs in 30%-63%23 and is characteristically described as a serous retinal detachment. Brown et al3 reviewed 75 patients with optic nerve pits and found that 24 of the 38 patients with macular detachments had cystic changes in the macula. Lamellar macular holes were present in the outer layer of the retina in 10 ofthe 24 eyes. Lincoff et al noted an associated retinoschisis in patients with optic pits. A macular hole was observed in the outer retinal layer in 14 out ofthe 15 eyes examined and was associated with severely diminished visual acuity. We now present a case of an optic nerve pit Figure 2 Earlyframefluorescein angiography discloses with retinoschisis and a outer layer detachment hypofluorescence ofthe optic nerve pit with an RPE with an external layer macular hole that was transmission defect in thefovea. treated promptly with krypton red barrier photocoagulation. The marked visual improve- had a 0-2 cup/disc ratio with a optic pit at the ment seen in our patient corresponded to the temporal border. A schisis-like elevation of the resolution of the external layer macular hole retina was observed extending temporally from observed clinically and on fluorescein the optic pit to the macula area.
    [Show full text]
  • Challenges in Optic Disc Pit Maculopathy Treatment
    Challenges in Optic Disc Pit Maculopathy Treatment Many techniques have been described; choose the best one for the individual patient. BY BARBARA PAROLINI, MD; AND MICHELE PALMIERI, MD ptic disc pit (ODP) is a rare congenital abnormality ODP MACULOPATHY of the optic nerve head, first described by Wiethe in ODP is usually asymptomatic, but a percentage of affected 1882.1 ODP usually appears as a grayish-whitish, round patients (25%-75% depending on the report) may develop a or oval depression of the optic disc (Figure 1A), and it macular serous detachment or a retinoschisis-like maculopa- may have different levels of severity. It is a spectrum of thy due to the presence, respectively, of subretinal or intra- Ocongenital cavitary anomalies of the optic disc, ranging from retinal fluid.3,6,9 This condition, known as ODP maculopathy the more common optic pit to the so-called morning glory (ODPM), causes visual impairment, especially in long-stand- syndrome (Figure 1B) to coloboma not only of the optic ing cases, in which lamellar or full-thickness macular holes nerve but also of the choroid (Figure 1C). It is also found in and retinal pigment epithelium atrophy may appear.10-12 the papillorenal syndrome determined by a mutation of the The exact mechanism of the pathophysiology of ODPM PAX2 gene. and the origin of the fluid remain unclear. It has been pro- ODP is bilateral in 15% of cases (Figure 2) and occurs posed that vitreous or cerebrospinal fluid (CSF) may be the equally in men and women with an estimated incidence of origin of the fluid
    [Show full text]
  • Multicenter Study of Pars Plana Vitrectomy for Optic Disc Pit
    Eye (2017) 31, 1266–1273 © 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved 0950-222X/17 www.nature.com/eye 1 2 3 4 5 CLINICAL STUDY Multicenter study of R Avci , Z Kapran ,S¸ Ozdek , MY Teke ,OOz, D Guven6, S Yilmaz1, B Kaderli7, AH Durukan8, pars plana vitrectomy G Sobaci9, YB Unver10, L Akduman11, for optic disc pit S Kaynak12, I Dogan13 and UU Inan14 maculopathy: MACPIT study Abstract 1Department of Ophthalmology, Retina Eye Hospital, Bursa, Turkey Purpose To evaluate surgical intervention except an arcuate scotoma or enlarged blind spot 2Department of Ophthalmology, Maltepe University Medical School, with pars plana vitrectomy (PPV) for in some cases. However, vision deteriorates if Istanbul, Turkey correction of optic disc pit maculopathy optic disc pit maculopathy (ODP-M) consisted 3Department of Ophthalmology, Gazi (ODP-M). mainly of serous macular detachment or University Medical School, Ankara, – Turkey Patients and methods Retrospective chart macular schisis develops.2 6 4Department of Ophthalmology, review from 13 centres of 51 eyes of 50 Although pars plana vitrectomy (PPV) is Ulucanlar Eye Education and Research Hospital, Ankara, Turkey patients with ODP-M who underwent PPV generally accepted as the standard procedure for – fi 5Department of Ophthalmology, Adana between 2002 2014. Anatomic and nal best- the management of ODP-M, the need for various – Retina Eye Center, Adana, Turkey corrected visual acuity (BCVA) outcomes adjuvant therapies has not been well studied.4 10 6Department of Ophthalmology, Sisli were evaluated for all cases with different Etfal Education and Research Hospital, The current study was designed in an attempt to Istanbul, Turkey adjuvant techniques.
    [Show full text]
  • An Insight Into the Pathogenesis of Optic Disc Pit–Associated Maculopathy with Enhanced Depth Imaging
    Research Brief Report An Insight Into the Pathogenesis of Optic Disc Pit–Associated Maculopathy With Enhanced Depth Imaging Jaitra P. Gowdar, DNB; Bindu Rajesh, MS; Anantharaman Giridhar, MS; Mahesh Gopalakrishnan, MS; Rameez Hussain, MS; Thomas Thachil, MS IMPORTANCE Optic disc pit with associated maculopathy is a known entity. However, controversy exists regarding the source of subretinal fluid in these cases. In our series, we attempted to analyze the morphologic changes seen in the optic disc pit and evaluate the source of subretinal fluid. OBSERVATIONS In this prospective observational case series of 4 patients with optic pit maculopathy, a complete ophthalmic evaluation, with fundus color photography and enhanced depth imaging spectral-domain optical coherence tomography scanning of the optic disc, was carried out between January 2013 and November 2013. The optical coherence tomographic section was mapped with infrared image and color photography, and the characteristics of the retina and optic nerve head were analyzed. All the cases had outer layer retinal schisis; 2 of them had associated serous macular detachment while inner retinal schisis was present in 3 cases. A hyporeflective tract was observed in our study connecting the retinal schisis cavity and gap in the lamina cribrosa corresponding to the optic pit. CONCLUSIONS AND RELEVANCE In our study, we demonstrated the connectivity between retinal schisis and the gap in the lamina cribrosa present in the optic disc pit, supporting the Author Affiliations: Giridhar Eye hypothesis of cerebrospinal fluid as the source of subretinal fluid. Institute, Kerala, India. Corresponding Author: Bindu Rajesh, MS, Giridhar Eye Institute, JAMA Ophthalmol. 2015;133(4):466-469.
    [Show full text]
  • Optic Nerve Cyst Associated with Optic Disc Pit in a Child with Multi-Cystic Kidney
    Central JSM Clinical Case Reports Case Report *Corresponding author Verlyn Yang, Department of Ophthalmology, Gold Coast University Hospital, Australia, Email: yangverlyn@ Optic Nerve Cyst Associated gmail.com Submitted: 16 August, 2020 with Optic Disc Pit in a Child Accepted: 08 September, 2020 Published: 09 September, 2020 Copyright © 2020 Yang V, et al. with Multi-Cystic Kidney ISSN: 2373-9819 OPEN ACCESS Verlyn Yang1*, Sandeep Bhuta2, and Aditi Kirpalani1 1Department of Ophthalmology, Gold Coast University Hospital, Australia Keywords 2Department of Radiology, Gold Coast University Hospital, Australia • Optic nerve cys • Optic disc pit • Coloboma Abstract • ODP-M In this case report, we present an unusual case of a 7-year-old female who came to the attention of the Ophthalmology department for reduced vision in the right eye 6/18 (LogMAR 0.4) with normal vision in the left eye. Fundoscopic examination revealed signs of an optic disc coloboma associated with an optic disc pit with adjacent sub-retinal fluid extending to the macula. She was born with a left multi-cystic kidney. Further work-up in the form of MRI and USG Orbits demonstrated a well-defined optic pit at the optic nerve head and a tubular channel extending to a 6-7mm multi-cystic lesion. ABBREVIATIONS mother had been diagnosed with Stragardt’s disease. There were no other systemic, familial or genetic conditions of note. Optic disc pit maculopathy (ODP-M); Magnetic Resonance Imaging (MRI) On examination, her visual acuity was noted to be right eye: INTRODUCTION Congenital optic disc pit is an uncommon congenital nerve6/18 (LogMAR appearance 0.4), in left the eye: right 6/9 eye (LogMAR on fundus 0.1), examination.
    [Show full text]
  • Glaucoma and the Optic Nerve Naida Jakirlic, OD, FAAO Western University of Health Sciences College of Optometry
    Glaucoma and the Optic Nerve Naida Jakirlic, OD, FAAO Western University of Health Sciences College of Optometry September 13, 2015 Learning objectives • Review the anatomy of the optic nerve • Recognize the appearance of the healthy optic nerve • Ascertain the critical components of optic nerve assessment • Identify possible glaucomatous changes of the optic nerve, peripapillary region, and RNFL • Identify the cardinal features of glaucomatous optic neuropathy • Analyze optic nerve images to solidify today’s discussion What is glaucoma? . A progressive optic nerve disease characterized by retinal ganglion cell death and resultant axon loss seen as excavation of the optic nerve head with consequent defects in retinal sensitivity that can be measured with visual field tests What is glaucoma? • Optic neuropathy • Axon loss • Excavation of the optic nerve • Resultant VF defects Glaucomatous damage may be due to • Elevated IOP • Poor perfusion pressure to the ONH • Obstruction of axoplasmic flow within the ganglion cell axons • Anatomic weakening of the lamina cribrosa ▫ Myopia ▫ Optic nerve pits • Programmed cell death of the ganglion cell axons (apoptosis) Pre-perimetric glaucoma? 20-40% of ganglion cells are lost before VF defects are detected on standard automated perimetry So what? Assessment of the ONH is critical for early diagnosis and management to prevent VF defects before they occur Optic Nerve Head (ONH) • Careful evaluation of the ONH has high specificity and good precision for glaucoma diagnosis • It is one of the most important
    [Show full text]
  • Congenital Anomalies of the Optic Nerve
    Saudi Journal of Ophthalmology (2015) 29, 32–38 Neuro-ophthalmology Update Congenital anomalies of the optic nerve ⇑ Manuel J. Amador-Patarroyo, Mario A. Pérez-Rueda , Carlos H. Tellez Abstract Congenital optic nerve head anomalies are a group of structural malformations of the optic nerve head and surrounding tissues, which may cause congenital visual impairment and blindness. Each entity in this group of optic nerve anomalies has individually become more prevalent as our ability to differentiate between them has improved due to better characterization of cases. Access to better medical technology (e.g., neuroimaging and genetic analysis advances in recent years) has helped to expand our knowl- edge of these abnormalities. However, visual impairment may not be the only problem in these patients, some of these entities will be related to ophthalmologic, neurologic and systemic features that will help the physician to identify and predict possible out- comes in these patients, which sometimes may be life-threatening. Herein we present helpful hints, associations and management (when plausible) for them. Keywords: Coloboma, Congenital, Optic disc excavation, Systemic anomalies, Optic nerve malformations Ó 2014 Production and hosting by Elsevier B.V. on behalf of Saudi Ophthalmological Society, King Saud University. http://dx.doi.org/10.1016/j.sjopt.2014.09.011 Introduction However, visual impairment may not be the only problem in these patients, some of these entities will be related to oph- Congenital malformations of the optic nerve, especially thalmologic, neurologic and systemic features (especially those involving the optic nerve head and surrounding tissues, endocrinologic disturbances) that will help the physician to include a broad spectrum of malformations frequently associ- identify and predict possible outcomes in these patients, ated with congenital blindness or significant visual impair- which sometimes may be life-threatening.4–6 ment.
    [Show full text]
  • Coexistence of Optic Pit and Coloboma of Iris, Lens, and Choroid
    CASE REPORT Coexistence of optic pit and coloboma of iris, lens, and choroid: a case report Coexistência de fosseta óptica e coloboma de íris, cristalino e coroide: um primeiro relato de caso RAMAZAN ÖZELCE1, VUSLAT GÜRLÜ1, HANDE GÜÇLÜ1, Sadık ALTAN ÖZAL1 ABSTRACT RESUMO A 42-year-old woman was admitted to our clinic with a complaint of glare in both Uma mulher de 42 anos de idade foi internada em nossa clínica com queixa de ofus- eyes. Biomicroscopic examination of both the eyes revealed iris and lens colobomas camento em ambos os olhos. O exame biomicroscópico revelou coloboma de íris e in the inferior quadrant. Fundus examination of the right eye revealed an oval and cristalino no quadrante inferior em ambos os olhos. O exame de fundo do olho direito gray inferotemporal optic pit and two choroid colobomas in the inferior quadrant. revelou um fosseta óptica oval e acinzentada na região inferotemporal e dois colobomas In the left eye, two choroid colobomas were detected that were inferior to the coroide no quadrante inferior. No olho esquerdo, dois colobomas de coroide foram optic nerve head. Furthermore, a 21-year-old man presented to our clinic for a detectados inferiormente à da cabeça do nervo óptico. Outro homem de 21 anos routine ophthalmologic examination. Bilateral biomicroscopic examination was apresentou-se em nossa clínica para um exame oftalmológico de rotina. O exame normal. Fundus examination of the left eye revealed an oval and gray inferotem- bio microscópico foi normal, bilateralmente. O exame de fundo do olho esquerdo poral optic pit and a choroid coloboma that was inferior to the optic nerve head.
    [Show full text]
  • Optic Disc Pit Maculopathy: When and How to Treat?
    Moisseiev et al. Int J Retin Vitr (2015) 1:13 DOI 10.1186/s40942-015-0013-8 REVIEW Open Access Optic disc pit maculopathy: when and how to treat? A review of the pathogenesis and treatment options Elad Moisseiev1,2,3*, Joseph Moisseiev4,2 and Anat Loewenstein1,2 Abstract Optic disc pit (ODP) is a rare congenital anomaly of the optic disc, which can be complicated by a maculopathy asso- ciated with progressive visual loss. Optic disc pits are usually unilateral and sporadic in occurrence, and the develop- ment of maculopathy is unpredictable with no known triggers. Optic disc pit maculopathy (ODP-M) is characterized by intraretinal and subretinal fluid at the macula, causing visual deterioration. The source of this fluid is still unclear, and several competing theories have suggested it may be vitreous fluid, cerebrospinal fluid, leakage from blood ves- sels at the base of the pit or leakage from the choroid. The mechanism of pathogenesis of ODP-M has not been fully elucidated, but vitreous liquefaction and traction and pressure gradients within the eye have been implicated to be involved. There are no clear guidelines on the management of patients with ODP-M, and numerous techniques have been described, including laser photocoagulation, intravitreal gas injection, macular buckling and pars plana vitrec- tomy with many different modifications. The majority of reports describe small series, and as there are no comparative studies there is no consensus regarding the optimal treatment for ODP-M. This review discusses the literature on the possible sources of fluid and mechanisms of pathogenesis in ODP-M, as well as the wide array of treatment modali- ties and their results.
    [Show full text]
  • Double Optic Discs, Optic Disc Coloboma, And
    Figure 2. Optical coherence tomographic image of the right eye Figure 3. Microperimetry of the right eye with a scanning laser corresponding to the scan line indicated by the arrow. Some of the outer ophthalmoscope. (size, Goldmann I; brightness, −15 dB; background, 10 retinal layers other than the nerve fiber layer appear to be absent in the areas candelas/m2). The patient did not recognize the stimulus at the positions of the cleavages. indicated by the red P s. profile of the inner retinal cleavages never see small bundles of nerve fi- (Figure 2). The mean±SD thick- ber passing across the RNFL de- Double Optic Discs, Optic ness of the retina at the site of the fect. However, there should be many Disc Coloboma, and Pit: cleavages was 106.4±17.7 m and that cases in which we cannot make a Spectrum of Hybrid Disc of the adjacent unaffected retina was clear distinction between them just Anomalies in a Single Eye 254.2±25.8 m. The mean thickness by fundoscopic appearance. Opti- of the retina at the site of the cleav- cal coherence tomographic imag- ages was significantly thinner than ing should be very useful in such Doubling of the optic disc is rare and that of the adjacent unaffected retina cases in making a correct diagnosis. is seen as true doubling or pseudo- (PϽ.001, Mann-Whitney U test). The The optical coherence tomo- doubling. We describe a peculiar case with multiple anomalies involv- fluorescein angiograms showed no graphic images showed the cleav- ing a single optic disc: a coloboma abnormalities.
    [Show full text]