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

      case-report

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          Abstract

          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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          Most cited references13

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          Crater-like holes in the optic disc and central serous retinopathy.

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            Imaging congenital optic disc pits and associated maculopathy using optical coherence tomography.

            To elucidate the anatomy of congenital optic disc pits with and without maculopathy using optical coherence tomography. All patient were examined, photographed, and scanned at the New York Eye and Ear Infirmary. Ten eyes of eight consecutive patients with congenital optic disc pits were studied. Three eyes had associated serous macular detachment (group 1), four had evidence of resolved detachment (group 2), and three had no clinical macular pathologic lesion (group 3). Optical coherence tomography, a new, noninvasive, noncontact, imaging technology capable of producing cross-sectional images of the retina in vivo with high resolution ( < 17 microns) was used to obtain multiple cross-sectional images of the pit, peripapillary retina, and macula. Ophthalmologic examination and standard fundus photography were performed on all eyes. Fluorescein angiography was performed in eyes that had associated macular detachment. Communication between a schisis cavity or subretinal space and the optic nerve pit was imaged in all eyes in group 1. No such communication could be identified in groups 2 and 3. Cystic degeneration and schisis were imaged in the peripapillary retina, macula, or both in all eyes of groups 1 and 2 and in one patient in group 3. A direct communication between the subretinal space and vitreous cavity could not be identified in any eye. Schisis formation plays an integral role in the development of serous retinal detachment in the presence of congenital optic disc pits. Our findings are consistent with the theory that the optic disc pit acts as a conduit for fluid flow between the schisis cavity or subretinal space and the subarachnoid space.
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              Long-term visual outcome in patients with optic nerve pit and serous retinal detachment of the macula.

              Serous detachment of the macula is a well-known complication in patients with an optic nerve pit. Despite the many descriptions of this condition and possible treatment options, the long-term natural history is not well known. The authors identified 15 eyes of 15 consecutive patients seen over 21 years who were diagnosed with a serous detachment of the macula arising from an optic nerve pit. Average length of follow-up was 9 years. Twelve eyes lost three or more lines of vision, two eyes remained unchanged, and only one eye improved. All of the 12 eyes losing three or more lines of vision experienced this decrease within the first 6 months of follow-up. Although only two patients had a visual acuity of 20/200 or less initially, 12 of 15 patients had a visual acuity of 20/200 or less at the time of their last examination. The appearance of the macula at last examination included cystic changes of the neurosensory retina, full-thickness hole formation, retinal pigment epithelial mottling, and lamellar hole formation in the outer retinal layer. The long-term visual prognosis in patients with optic nerve pit and untreated serous retinal detachment of the macula is poor, and visual loss occurs within 6 months of the serous detachment.
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                Author and article information

                Journal
                Korean J Ophthalmol
                KJO
                Korean Journal of Ophthalmology : KJO
                The Korean Ophthalmological Society
                1011-8942
                2092-9382
                December 2011
                22 November 2011
                : 25
                : 6
                : 455-458
                Affiliations
                Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea.
                Author notes
                Corresponding Author: Ki Bang Uhm, MD, PhD. Department of Ophthalmology, Hanyang University College of Medicine, #17 Haengdang-dong, Seongdong-gu, Seoul 133-791, Korea. Tel: 82-2-2290-8570, Fax: 82-2-2291-8517, KBUhm@ 123456hanyang.ac.kr
                Article
                10.3341/kjo.2011.25.6.455
                3223716
                22131786
                3b3ea443-4bdd-4456-b865-afd538b1cb95
                © 2011 The Korean Ophthalmological Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 August 2010
                : 02 November 2011
                Categories
                Case Report

                Ophthalmology & Optometry
                retinoschisis,optic disc,glaucoma
                Ophthalmology & Optometry
                retinoschisis, optic disc, glaucoma

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