Peripapillary retinal splitting visualized on OCT in glaucoma and glaucoma suspect patients

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Abstract

Purpose

To identify the risk factors for development of peripapillary retinal splitting (schisis) in patients with glaucoma or suspicion of glaucoma

Setting

Glaucoma Clinic, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL

Methods

In this institutional cross-sectional study, 495 patients (990 eyes) who had undergone spectral-domain optical coherence tomography (OCT Spectralis HRA-OCT, Heidelberg Engineering) optic nerve head (ONH) imaging and did not have identifiable optic nerve pits, pseudopits or coloboma were included. OCT scans were reviewed by two observers.

Main outcome measures

Presence of peripapillary retinal splitting identified on OCT raster scans.

Results

Eleven of 990 glaucoma and glaucoma suspect eyes (1.1%) of 7 patients (2 females, 5 males, mean age 64.5 ± 9.2 years) had peripapillary retinal splitting. Two of these 11 eyes had extension of the splitting into the macula but none to the fovea. Of these 11 patients, 2 (28.6%) were glaucoma suspects, 3 (42.9%) had primary open-angle glaucoma, 1 (14.3%) had chronic angle-closure glaucoma and 1 (14.3%) had pigmentary glaucoma. 7/11 (63.6%) eyes had vitreous traction to the disc visualized on OCT and 6/11 eyes (54.5%) had beta-zone peripapillary atrophy.

Conclusions

We observed peripapillary retinal splitting in 1.1% of a series of 990 glaucoma and glaucoma-suspect eyes. Evidence of adherent vitreous with traction and peripapillary atrophy was found in a majority of the involved eyes. A comparison to an age and axial length matched cohort is required to determine if this is a condition that is associated with glaucoma.

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Most cited references 41

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Optic disc pit: a review.

Ilias Georgalas, Petros Petrou, Gerasimos Georgopoulos … (2011)

Since Wiethe first described the clinical presentation of two optic disc depressions in a 62-year-old woman in 1882, there have been many studies addressing what later become known as the "optic disc pit." The main complication of this condition, termed optic disc pit maculopathy, is associated with visual deterioration. Treatment of optic disc pit maculopathy remains challenging. Here we review the body of literature that documents the clinical findings, pathophysiology, histology, main complications, treatment options, special features and presentations, and differential diagnosis of optic disc pit. The source of the intraretinal fluid in optic disc pit maculopathy remains controversial. Four possible sources of this fluid have been proposed: fluid from the vitreous cavity; cerebrospinal fluid originating from the subarachnoid space; fluid from leaky blood vessels at the base of the pit; and fluid from the orbital space surrounding the dura. Optic disc pits are a very rare clinical entity, affecting approximately one in 11,000 people. Patients with congenital optic disc pit sometimes remain asymptomatic, but 25% to 75% present with visual deterioration in their 30s or 40s after developing macular schisis and detachment. The most widely accepted treatment for such patients is a surgical approach involving pars plana vitrectomy with or without internal limiting membrane peeling, with or without endolaser photocoagulation and C3F8 endotamponade.

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Enhanced depth imaging optical coherence tomography of deep optic nerve complex structures in glaucoma.

Sung Park, Carlos De Moraes, Christopher C Teng … (2012)

To assess the usefulness of enhanced depth imaging (EDI) optical coherence tomography (OCT) for evaluating deep structures of the optic nerve complex (ONC; optic nerve head and peripapillary structures) in glaucoma. Prospective, observational study. Seventy-three established glaucoma patients (139 eyes) with a range of glaucomatous damage. Serial horizontal and vertical EDI OCT images of the ONC were obtained from both eyes of each participant. Deep ONC structures, including the lamina cribrosa (LC), short posterior ciliary artery (SPCA), central retinal artery (CRA), central retinal vein (CRV), peripapillary choroid and sclera, and subarachnoid space around the optic nerve, were investigated for their visibility and morphologic features. Deep ONC structures identified in EDI OCT images. Visual field mean deviation of 139 included eyes was -11.8 ± 8.6 dB (range, -28.70 to -2.01 dB). The anterior laminar surface was identified in all eyes in the central laminar area and in 91 (65%) eyes in the periphery beneath the neuroretinal and scleral rims or vascular structures. The LC pores with various shapes and sizes were visualized in 106 (76%) eyes, mainly in the central and temporal areas of the LC. Localized LC lesions seen on optic disc photographs were identified as focal LC defects (partial loss of LC tissue) in the EDI OCT images. The locations of the CRA and CRV were identified in all eyes. In the LC, the CRA maintained a straight shape with a consistent caliber, but the CRV (and tributaries) assumed a more irregular shape. The SPCAs, their branches through the emissary canals in the sclera, or both were visualized in 120 (86%) eyes. The subarachnoid space around the optic nerve was identified with varying degrees of clarity in 25 eyes (18%): 17 had high myopia and extensive parapapillary atrophy. Intrachoroidal cavitation or choroidal schisis, which had been unrecognized clinically, was identified in 2 eyes (1%) with high myopia. Enhanced depth imaging OCT was able to visualize a wide variety of deep ONC structures in glaucoma patients and may be helpful in detecting, conceptualizing, and understanding basic and complicated in vivo anatomic and pathologic features of the ONC in glaucoma. Proprietary or commercial disclosure may be found after the references. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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Vitrectomy without laser treatment or gas tamponade for macular detachment associated with an optic disc pit.

Akito Hirakata, Makoto Inoue, Tomoyuki Hiraoka … (2012)

To evaluate the clinical outcomes after vitrectomy, without gas tamponade or laser photocoagulation to the margin of the optic nerve, for the treatment of macular detachment associated with optic disc pits and to characterize retinal manifestations during treatment of optic pit maculopathy using optical coherence tomography (OCT).

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Author and article information

Contributors

Dilraj S. Grewal: Role: ConceptualizationRole: Writing – original draftRole: Writing – review & editing

Daniel J. Merlau: Role: Data curation

Pushpanjali Giri: Role: Data curation

Marion R. Munk: Role: Writing – review & editing

Amani A. Fawzi: Role: InvestigationRole: Writing – review & editing

Lee M. Jampol: Role: SupervisionRole: Writing – review & editing

Angelo P. Tanna:

ORCID: http://orcid.org/0000-0003-3089-6664

Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing

Demetrios G. Vavvas: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 23 August 2017

Publication date Collection: 2017

Volume: 12

Issue: 8

Electronic Location Identifier: e0182816

Affiliations

[001]Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America

Massachusetts Eye & Ear Infirmary, Harvard Medical School, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

[¤a]

Current address: Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States of America

[¤b]

Current address: Columbia University, New York, New York, United States of America

* E-mail: atanna@ 123456northwestern.edu

Author information

Angelo P. Tanna http://orcid.org/0000-0003-3089-6664

Article

Publisher ID: PONE-D-17-08291

DOI: 10.1371/journal.pone.0182816

PMC ID: 5568282

PubMed ID: 28832670

SO-VID: 96be1b20-f99f-4a50-930a-a5b8edf55a88

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 1 March 2017

Date accepted : 25 July 2017

Page count

Figures: 3, Tables: 2, Pages: 13

Funding

Funded by: funder-id http://dx.doi.org/10.13039/100001818, Research to Prevent Blindness;

Funded by: funder-id http://dx.doi.org/10.13039/100005242, Heed Ophthalmic Foundation;

Award Recipient : Dilraj S. Grewal

Funded by: Ronald G Michels Fellowship Foundation

Award Recipient : Dilraj S. Grewal

Supported by an unrestricted grant from Research to Prevent Blindness, NY to the Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Heed Ophthalmic Foundation (San Francisco, CA) and Ronald G. Michels Fellowship Foundation (Riderwood, MD) (DSG). None of the authors have any financial or proprietary interest in this manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Data Availability All relevant data are within the paper and its Supporting Information files.

Peripapillary retinal splitting visualized on OCT in glaucoma and glaucoma suspect patients

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Abstract

Purpose

Setting

Methods

Main outcome measures

Results

Conclusions

Related collections

PLOS Climate

Most cited references 41

Optic disc pit: a review.

Enhanced depth imaging optical coherence tomography of deep optic nerve complex structures in glaucoma.

Vitrectomy without laser treatment or gas tamponade for macular detachment associated with an optic disc pit.

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