Acquired Pits of the Optic Nerve

Background: The origin of the fluid and precise pathophysiology of optic pit maculopathy remain unclear. It has been suggested that submacular fluid originates either from vitreous or cerebrospinal fluid. We report a case of optic pit maculopathy which was unsuccessfully treated with vitrectomy and internal limiting membrane (ILM) peeling, and subsequently resolved with revision of vitrectomy and gas tamponade. Methods: We report a case of optic disc pit maculopathy, well documented by spectral- domain optical coherence tomography, before and after pars plana vitrectomy with ILM peeling, and its revision with gas tamponade. Results: After ILM peeling, there was no improvement either in visual acuity or in the tomographic aspect of the retina. A revision of the surgery was then needed and gas tamponade was performed, which resulted in a complete resolution of the optic pit maculopathy. Conclusion: The absence of improvement after ILM peeling during the first surgical procedure, accompanied by resolution of the clinical picture with gas tamponade during the second surgical procedure, sustained the hypothesis of a subarachnoidal origin of the fluid.

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“…Subsequently, a number of authors confirmed these findings in clinic-based case-control studies [13–15]. …”

Section: Introductionmentioning

confidence: 80%

Double-Vitrectomy for Optic Disc Pit Maculopathy

Pichi

Morara

Veronese

et al. 2012

Case Rep Ophthalmol

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“…[13] Hemorrhages may simply indicate poor control and thus are more frequent in NTG in which substantial lowering of pressure is more difficult to achieve.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Normal-tension glaucoma (Low-tension glaucoma)

Anderson

2011

Indian J Ophthalmol

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Glaucoma is now considered an abnormal physiology in the optic nerve head that interacts with the level of intraocular pressure (IOP), with the degree and rate of damage depending on the IOP and presumably the degree of abnormal physiology. Diagnosis of normal-tension glaucoma (NTG), defined as glaucoma without a clearly abnormal IOP, depends on recognizing symptoms and signs associated with optic nerve vulnerability, in addition to absence of other explanations for disc abnormality and visual field loss. Among the findings are a halo or crescent of absence of retinal pigment epithelium around the disc, bilateral pre-chiasmal visual field defects, splinter hemorrhages at the disc margin, vascular dysregulation (low blood pressure, cold hands and feet, migraine headache with aura, and the like), or a family history of glaucoma. Possibly relevant, is a history of hemodynamic crisis, arterial obstructive disease, or sleep apnea. Neurological evaluation with imaging is needed only for atypical cases or ones that progress unexpectedly. Management follows the same principle of other chronic glaucomas, to lower the IOP by a substantial amount, enough to prevent disabling visual loss. However, many NTG cases are non-progressive. Therefore, it may often be wisein mild cases to determine whether the case is progressive and the rate of progression before deciding on how aggressivene to be with therapy. Efforts at neuroprotection and improvement in blood flow have not yet been shown effective.

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“…Radius et al described incident pits of the optic disc in open-angle glaucoma, both clinically and histologically, demonstrating an association with glaucoma progression [9]. In addition, a number of authors have confirmed these findings in clinic-based case-control studies [10-12]. Also, Healey and Mitchell [13] reported that optic disc pits are associated with glaucoma and the related signs of optic disc hemorrhage and β-peripapillary atrophy.…”

Section: Discussionmentioning

confidence: 99%

Optic Disc Pit with Peripapillary Retinoschisis Presenting as a Localized Retinal Nerve Fiber Layer Defect

Song

Shin

et al. 2011

Korean J Ophthalmol

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A 59-year-old woman was referred to our clinic for a glaucoma evaluation. The visual acuity and intraocular pressure were normal in both eyes. However, red-free fundus photography in the left eye showed a superotemporal wedge-shaped retinal nerve fiber layer defect, and visual field testing showed a corresponding partial arcuate scotoma. In an optical coherence tomography examination, the macula was flat, but an arcuate-shaped peripapillary retinoschisis was found. Further, the retinoschisis seemed to be connected with a superotemporal optic pit shown in a disc photograph. After 3 months of a topical prostaglandin analogue medication, the intraocular pressure in the retinoschisis eye was lowered from 14 to 10 mmHg and the peripapillary retinoschisis was almost resolved. We report a rare case of an optic disc pit with peripapillary retinoschisis presenting as a localized retinal nerve fiber layer defect.

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Acquired Pits of the Optic Nerve

Cited by 102 publications

References 16 publications

Double-Vitrectomy for Optic Disc Pit Maculopathy

Double-Vitrectomy for Optic Disc Pit Maculopathy

Normal-tension glaucoma (Low-tension glaucoma)

Optic Disc Pit with Peripapillary Retinoschisis Presenting as a Localized Retinal Nerve Fiber Layer Defect

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