Serous maculopathy secondary to disc abnormalities

From EyeWiki


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.