Serous Maculopathy Secondary to Disc Abnormalities
Serous maculopathy secondary to optic disc abnormalities
Disease
Types
- Serous maculopathy associated with optic nerve head pit
- Serous maculopathy associated with tilted disc syndrome
- Serous maculopathy associated with dysplastic disc
- Serous maculopathy associated with optic nerve head coloboma
Serous maculopathy associated with optic nerve head pit
History: Wiethe was the first one to describe this condition in 1882. Clinical Features: It is seen as greyish-white excavation in optic nerve head, often in the temporal disc.
- Size of the disc is normal
- Subretinal fluid extending from disc and involving macula which may wax and wane naturally without intervention
Pathophysiology: Subretinal fluid origin is debated, but derivation is thought to be from:
- Vitreous
- Subarachnoid space
- Abnormal vessels from base of the pit
Treatment:
- Observation
- Intravitreal gas injection
- Pars plana vitrectomy with many possible components or combination of components, including:
- Laser photocoagulation along the temporal disc margin
- Internal limiting membrane peeling, sometimes laying the membrane graft over the pit defect
- Air-fluid exchange
- Intravitreal gas injection
- Injection of autologous platelet-rich plasmin or fibrin glue into the optic pit has been reported
Serous maculopathy associated with tilted disc syndrome
Clinical Features:
- Presence of tilted disc (superotemporal part of optic disc lying anterior to inferonasal part of disc)
- Presence of posterior staphyloma with RPE atrophy at the edge of staphyloma
Investigations:
- FFA: multiple pinpoint leakages at the site of RPE atrophy
- OCT: Serous macular detachment
Differential Diagnosis: Chronic CSR
Management: Photocoagulation to leakage site
Serous maculopathy associated with dysplastic disc
Clinical Features: Disc dysplasia, or an abnormally-looking disc that does not fit into any other recognizable category
Pathophysiology: Could be similar to that of optic nerve head pit
Management: Photocoagulation along temporal margin of disc has been described
Serous maculopathy associated with optic nerve head coloboma
Clinical Features: Enlarged disc with white glistening excavation within it
- Subretinal fluid underneath macula extending from optic nerve
Pathophysiology: Subretinal fluid may arise from
- Fluid entering into the retrobulbar space from surrounding orbital tissue
- Peripapillary choriocapillaris
- CSF
Management: Photocoagulation along temporal margin of disc has been described
Serous maculopathy associated with morning glory syndrome
Clinical features: Funnel shaped excavation of the posterior pole involving optic disc
- Usually unilateral if bilateral hereditary
- Serous macular involvement in 30% cases
References
1. Ryan SJ, Schachat AP, Wilkinson CP, Hinton DR, Sadda SR, Wiedemann P. Retina. fifth edition Vol 1. Elsevier Health Sciences; 2012.
2. Bowling B (Bradley). Kanski’s Clinical Ophthalmology : A Systematic Approach. Elsevier; 2016.
3. Cohen SY, Quentel G, Guiberteau B, Delahaye-Mazza C, Gaudric A. Macular serous retinal detachment caused by subretinal leakage in tilted disc syndrome. Ophthalmology. 1998;105(10):1831-1834.
4. Gopal L, Rao C, Sharma S. Serous macular detachment associated with dysplastic disc. Indian J Ophthalmol. 2007;55(3):224-225.
5. Lin CCL, Tso MOM, Vygantas CM. Coloboma of Optic Nerve Associated With Serous Maculopathy. Arch Ophthalmol. 1984;102(11):1651.
6. Moisseiev, E., Moisseiev, J., Loewenstein, A. Optic disc pit maculopathy: when and how to treat? A review of the pathogenesis and treatment options. International Journal of Retina and Vitreous. 2015;1:13.
