Difference between revisions of "Serous Maculopathy Secondary to Disc Abnormalities"

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Serous maculopathy secondary to optic disc abnormalities
 
Serous maculopathy secondary to optic disc abnormalities
1) Types  
+
 
  Serous maculopathy associated with optic nerve head pit
+
= Disease =
  Serous maculopathy associated with tilted disc syndrome
+
== Types ==
  Serous maculopathy associated with dysplastic disc
+
* Serous maculopathy associated with optic nerve head pit
  Serous maculopathy associated with optic nerve head coloboma
+
* Serous maculopathy associated with tilted disc syndrome
2) Serous maculopathy associated with optic nerve head pit
+
* Serous maculopathy associated with dysplastic disc
History: Wiethe was the first one to describe this condition in 1882.
+
* Serous maculopathy associated with optic nerve head coloboma
Clinical Features: It is seen as greyish white excavation in optic nerve head.
+
 
                                Size of the disc is normal
+
=== Serous maculopathy associated with optic nerve head pit ===
                                Subretinal fluid extending from disc and involving macula
+
'''History:''' Wiethe was the first one to describe this condition in 1882.
Pathophysiology: Subretinal fluid is derived from
+
'''Clinical Features:''' It is seen as greyish white excavation in optic nerve head.
                                -Vitreous
+
* Size of the disc is normal
                                -Subarachnoid space
+
* Subretinal fluid extending from disc and involving macula
                                -Abnormal vessels from base of the pit
+
 
Treatment : Photocoagulation along temporal margin of the disc with intravitreal gas  
+
 
                      Injection
+
'''Pathophysiology:''' Subretinal fluid is derived from
                      Pars plana vitrectomy with fluid gas exchange with photocoagulation along  
+
* Vitreous
                      temporal margin of the disc - more effective
+
* Subarachnoid space
                     
+
* Abnormal vessels from base of the pit
3) 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)
+
'''Treatment:''' Photocoagulation along temporal margin of the disc with intravitreal gas  
                                Presence of posterior staphyloma with RPE atrophy at the edge of  
+
* Injection
                                Staphyloma
+
* Pars plana vitrectomy with fluid gas exchange with photocoagulation along temporal margin of the disc - more effective
                               
+
                   
Investigations: FFA: multiple pin point leakages at the site of RPE atrophy
+
=== Serous maculopathy associated with tilted disc syndrome ===
                          OCT: Serous macular detachment
+
'''Clinical Features:'''
Differential Diagnosis: Chronic CSR
+
* Presence of tilted disc (superotemporal part of optic disc lying anterior to inferonasal part of disc)
Management: Photocoagulation to leakage site
+
* Presence of posterior staphyloma with RPE atrophy at the edge of Staphyloma
4) Serous maculopathy associated with dysplastic disc
+
 
Clinical Features: Disc dysplasia is abnormally looking disc that does not fit into any other  
+
 
                                Recognizable category
+
'''Investigations:'''
Pathophysiology : Could be similar to that of optic nerve head pit
+
* FFA: multiple pin point leakages at the site of RPE atrophy
Management: Photocoagulation along temporal margin of disc
+
* OCT: Serous macular detachment
5) 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
+
'''Differential Diagnosis:''' Chronic CSR
Pathophysiology: Subretinal fluid may arise from
+
'''Management:''' Photocoagulation to leakage site
                            - fluid perfusing into the retrobulbar space from surrounding orbital tissue
+
 
                            - peripapillary choriocapillaris
+
=== Serous maculopathy associated with dysplastic disc ===
                            - CSF
+
'''Clinical Features:''' Disc dysplasia is abnormally looking disc that does not fit into any other  
Management: Photocoagulation along temporal margin of disc
+
* Recognizable category
6) Serous maculopathy associated with morning glory syndrome
+
 
Clinical features: Funnel shaped excavation of the posterior pole involving optic disc
+
 
                              Usually unilateral if bilateral heriditary
+
'''Pathophysiology:''' Could be similar to that of optic nerve head pit
                              Serous macular involvement in 30% cases
+
'''Management:''' Photocoagulation along temporal margin of disc
References:
+
 
1. Ryan SJ, Schachat AP, Wilkinson CP, Hinton DR, Sadda SR, Wiedemann P. Retina. fifth edition Vol  
+
=== Serous maculopathy associated with optic nerve head coloboma ===
1. Elsevier Health Sciences; 2012.
+
'''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 perfusing into the retrobulbar space from surrounding orbital tissue
 +
* Peripapillary choriocapillaris
 +
* CSF
 +
 
 +
 
 +
'''Management:''' Photocoagulation along temporal margin of disc
 +
 
 +
=== Serous maculopathy associated with morning glory syndrome ===
 +
'''Clinical features:''' Funnel shaped excavation of the posterior pole involving optic disc
 +
* Usually unilateral if bilateral heriditary
 +
* 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.
 
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.
 
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.
 
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.
 
5. Lin CCL, Tso MOM, Vygantas CM. Coloboma of Optic Nerve Associated With Serous Maculopathy. Arch Ophthalmol. 1984;102(11):1651.

Revision as of 12:19, December 11, 2017


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.

  • Size of the disc is normal
  • Subretinal fluid extending from disc and involving macula


Pathophysiology: Subretinal fluid is derived from

  • Vitreous
  • Subarachnoid space
  • Abnormal vessels from base of the pit


Treatment: Photocoagulation along temporal margin of the disc with intravitreal gas

  • Injection
  • Pars plana vitrectomy with fluid gas exchange with photocoagulation along temporal margin of the disc - more effective

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 pin point 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 is 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

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 perfusing into the retrobulbar space from surrounding orbital tissue
  • Peripapillary choriocapillaris
  • CSF


Management: Photocoagulation along temporal margin of disc

Serous maculopathy associated with morning glory syndrome

Clinical features: Funnel shaped excavation of the posterior pole involving optic disc

  • Usually unilateral if bilateral heriditary
  • 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.