Optic Disk Pit and Iridociliary Cyst Precipitating Angle Closure Glaucoma

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ABSTRACT

Primary angle closure glaucoma is usually a bilateral disease, though it may be asymmetrical. However, it is unusual to see advanced glaucoma in one eye and no disk damage in the other. We present a case of unilateral angle closure glaucoma complicated by an optic disk pit and iridociliary cysts.

How to cite this article: Kaushik S, Ichhpujani P, Kaur S, Pandav SS. Optic Disk Pit and Iridociliary Cyst Precipitating Angle Closure Glaucoma. J Current Glau Prac 2014;8(1): 33-35.

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Acquired pits of the optic nerve. Increased prevalence in patients with low-tension glaucoma.

Martin L Katz, R Addiego, E Poryzees … (1990)

The authors studied 232 glaucoma patients in an attempt to shed light on the implications of the pit-like localized cupping of the optic nerve often referred to as an "acquired pit of the optic nerve" (APON) both in low-tension glaucoma and in glaucoma associated with elevated intraocular pressure (IOP). Twenty (74%) of the 27 patients with low-tension glaucoma had APONs, whereas 31 (15%) of the 232 patients with elevated pressure did (P less than 0.001). Overall, there was no difference between the degree of field loss in patients with APONs and in those without. We suggest that APONs may signal an abnormal susceptibility of the optic nerve to the damaging effects of IOP.

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The etiology and treatment of macular detachment associated with optic nerve pits and related anomalies.

J Pulido, K. Johnson, Michael McNamara … (1997)

Up to two thirds of patients with optic disc pits develop a sight-limiting maculopathy. There is confusion regarding the etiology and nature of the maculopathy in these cases. We present 7 cases of serous macular detachment occurring in association with optic pits or related cavitary anomalies and identify a rhegmatogenous etiology. We reviewed the records of 7 patients with optic nerve anomalies and macular detachment. Patients were treated with observation, barricade laser, vitrectomy, and/or gas tamponade. Seven patients were noted to have serous macular detachment associated with an optic nerve pit or other cavitary anomaly. A hole or tear in the diaphanous tissue overlying the optic pit was identified in all cases. None of the patients had a posterior vitreous detachment. Two were treated with photocoagulation only, and 5 underwent pars plana vitrectomy with fluid-gas exchange with or without photocoagulation. Pretreatment visual acuity ranged from 20/30 to 6/200. Posttreatment acuity ranged from 20/25 to 20/100. Five of 7 eyes had final acuities of 20/30 or better, and all treated eyes improved. A tear in the diaphanous tissue overlying the optic nerve pit is responsible for the development of serous macular detachment and is consistent with findings in similar conditions, such as retinal detachment in association with chorioretinal coloboma. These tears may be quite subtle, and careful biomicroscopic examination is required to appreciate them. The treatment of this condition remains controversial. However, because of the relatively poor prognosis, we believe treatment should include the formation of a barricade to fluid movement as well as sealing and relief of traction from the hole. The value of laser treatment may be increased by the early identification of a defect in the diaphanous membrane prior to the development of macular detachment. Consideration of prophylactic laser might then reduce the need for later, more invasive measures, and improve the prognosis.

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Acquired pit of the optic nerve: a risk factor for progression of glaucoma.

Seyda Ugurlu, Marc Weitzman, Constance Nduaguba … (1998)

To examine acquired pit of the optic nerve as a risk factor for progression of glaucoma. In a retrospective longitudinal study, 25 open-angle glaucoma patients with acquired pit of the optic nerve were compared with a group of 24 open-angle glaucoma patients without acquired pit of the optic nerve. The patients were matched for age, mean intraocular pressure, baseline ratio of neuroretinal rim area to disk area, visual field damage, and duration of follow-up. Serial optic disk photographs and visual fields of both groups were evaluated by three independent observers for glaucomatous progression. Of 46 acquired pits of the optic nerve in 37 eyes of 25 patients, 36 pits were located inferiorly (76%) and 11 superiorly (24%; P < .001). Progression of optic disk damage occurred in 16 patients (64%) in the group with acquired pit and in three patients (12.5%) in the group without acquired pit (P < .001). Progression of visual field loss occurred in 14 patients (56%) in the group with acquired pit and in six (25%) in the group without pit (P=.04). Bilateral acquired pit of the optic nerve was present in 12 patients (48%). Disk hemorrhages were observed more frequently in the group with acquired pit (10 eyes, 40%) compared with the group without pit (two eyes, 8%; P=.02). Among patients with glaucoma, patients with acquired pit of the optic nerve represent a subgroup who are at increased risk for progressive optic disk damage and visual field loss.

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Author and article information

Contributors

Sushmita Kaushik

Parul Ichhpujani

Savleen Kaur

Surinder Singh Pandav

Journal

Journal ID (nlm-ta): J Curr Glaucoma Pract

Journal ID (iso-abbrev): J Curr Glaucoma Pract

Journal ID (publisher-id): JOCGP

Title: Journal of Current Glaucoma Practice

Publisher: Jaypee Brothers Medical Publishers

ISSN (Print): 0974-0333

ISSN (Electronic): 0975-1947

Publication date (Print): Jan-Apr 2014

Publication date (Electronic): 16 January 2014

Volume: 8

Issue: 1

Pages: 33-35

Affiliations

Associate Professor, Glaucoma Services, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Assistant Professor, Department of Ophthalmology, Government Medical College Chandigarh, India

Senior Resident, Glaucoma Services, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Professor, Glaucoma Services, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Author notes

Sushmita Kaushik, Associate Professor Glaucoma Services, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India Phone: 91-1722747837, e-mail: sushmita_kaushik@yahoo.com

Article

DOI: 10.5005/jp-journals-10008-1158

PMC ID: 4741157

PubMed ID: 26997805

SO-VID: 731d661b-4ecf-4f23-a2a6-82b248f914ba

License:

This work is licensed under a Creative Commons Attribution 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/3.0/

Optic Disk Pit and Iridociliary Cyst Precipitating Angle Closure Glaucoma

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ABSTRACT

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Most cited references 4

Acquired pits of the optic nerve. Increased prevalence in patients with low-tension glaucoma.

The etiology and treatment of macular detachment associated with optic nerve pits and related anomalies.

Acquired pit of the optic nerve: a risk factor for progression of glaucoma.

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