Retina/Uveitis Quiz 14

Rosa Y Kim, MD | Massachusetts Eye and Ear Infirmary, Harvard Medical School
Donald J. D'Amico, MD | Massachusetts Eye and Ear Infirmary, Harvard Medical School

January 14, 1997
Figure 1
This is the left eye of an asymptomatic patient.
Questions and Answers
1. What is the diagnosis?
Answer: Optic nerve pit.

2. What percentage of this condition is bilateral?
Answer: Approximately 10% to 15% of optic disc pits are bilateral.

3. What associated retinal changes can one see in this condition?
Answer: Peripapillary chorioretinal atrophy and RPE changes may develop over time. Forty to 50% of patients with optic nerve pits have macular detachment or retinal changes suggestive of previous detachment.

4. What types of visual field defects can be associated with this condition?
Answer: Simpson (1987) reported that the optic disc pit can be associated with arcuate scotomas, most likely reflecting the absence of the wedge of the nerve fibers displaced by the optic disc pit. Larger pits may be associated with large Bejerrum-type scotomas or even altitudinal visual field defects. Walsh and Hoyt demonstrated, however, that an enlarged blind spot is the predominant visual field defect associated with optic disc pits.

Another cause of visual field defects is an associated serous detachment of the macula, which would produce corresponding central visual field changes.

5. What treatment option is available for macular detachment?
Answer: Brockhurst (1975), Gass (1977), and Theodossiasdis (1977) used the argon laser to place burns in one or several rows between the areas of serous retinal detachment and the optic disc. They all reported good resolution of the serous detachment. However, the final visual outcome between the treated and untreated eyes in these studies was less pronounced.

6. What is the most widely accepted explanation for the serous detachment?
Answer: Sugar (1962) proposed that fluid FROM the vitreous leaking through the optic pit to fill the subretinal space was responsible for the detachment. This was later endorsed by Brockhurst (1975).