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

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|Authors=Prajakta.Patil
 
|Authors=Prajakta.Patil
 
|Category=Retina/Vitreous
 
|Category=Retina/Vitreous
|Assigned editor=Vinay.A.Shah.SEC
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|Assigned editor=Christina.weng
|Reviewer=Prajakta.Patil
+
|Reviewer=Christina.weng
|Date reviewed=June 1, 2017
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|Date reviewed=February 7, 2021
 
|Article status=Up to Date
 
|Article status=Up to Date
|Local Videos=
 
 
}}
 
}}
 
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, often in the temporal disc.
                                -Vitreous
+
* Size of the disc is normal
                                -Subarachnoid space
+
* Subretinal fluid extending from disc and involving macula which may wax and wane naturally without intervention
                                -Abnormal vessels from base of the pit
+
 
Treatment :  Photocoagulation along temporal margin of the disc with intravitreal gas  
+
 
                      Injection
+
'''Pathophysiology:''' Subretinal fluid origin is debated, but derivation is thought to be 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:'''  
                                Presence of posterior staphyloma with RPE atrophy at the edge of  
+
* Observation
                                Staphyloma
+
* Intravitreal gas injection
                               
+
* Pars plana vitrectomy with many possible components or combination of components, including:
Investigations: FFA: multiple pin point leakages at the site of RPE atrophy
+
** Laser photocoagulation along the temporal disc margin
                          OCT: Serous macular detachment
+
** Internal limiting membrane peeling, sometimes laying the membrane graft over the pit defect
Differential Diagnosis: Chronic CSR
+
** Air-fluid exchange
Management: Photocoagulation to leakage site
+
** Intravitreal gas injection
4) Serous maculopathy associated with dysplastic disc
+
** Injection of autologous platelet-rich plasmin or fibrin glue into the optic pit has been reported
Clinical Features: Disc dysplasia is abnormally looking disc that does not fit into any other  
+
                   
                                Recognizable category
+
=== Serous maculopathy associated with tilted disc syndrome ===
Pathophysiology : Could be similar to that of optic nerve head pit
+
'''Clinical Features:'''
Management: Photocoagulation along temporal margin of disc
+
* Presence of tilted disc (superotemporal part of optic disc lying anterior to inferonasal part of disc)
5) Serous maculopathy associated with optic nerve head coloboma
+
* Presence of posterior staphyloma with RPE atrophy at the edge of staphyloma
Clinical Features: Enlarged disc with white glistening excavation within it
+
 
                                Subretinal fluid underneath macula extending from optic nerve
+
 
Pathophysiology: Subretinal fluid may arise from
+
'''Investigations:'''
                            - fluid perfusing into the retrobulbar space from surrounding orbital tissue
+
* FFA: multiple pinpoint leakages at the site of RPE atrophy
                            - peripapillary choriocapillaris
+
* OCT: Serous macular detachment
                            - CSF
+
 
Management: Photocoagulation along temporal margin of disc
+
 
6) Serous maculopathy associated with morning glory syndrome
+
'''Differential Diagnosis:''' Chronic CSR
Clinical features: Funnel shaped excavation of the posterior pole involving optic disc
+
'''Management:''' Photocoagulation to leakage site
                              Usually unilateral if bilateral heriditary
+
 
                              Serous macular involvement in 30% cases
+
=== Serous maculopathy associated with dysplastic disc ===
References:
+
'''Clinical Features:''' Disc dysplasia, or an abnormally-looking disc that does not fit into any other recognizable category
1. Ryan SJ, Schachat AP, Wilkinson CP, Hinton DR, Sadda SR, Wiedemann P. Retina. fifth edition Vol  
+
 
1. Elsevier Health Sciences; 2012.
+
 
 +
'''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.
 
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.
 +
 +
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.

Latest revision as of 10:52, April 1, 2021


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.