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

From EyeWiki
 
(13 intermediate revisions by 3 users not shown)
Line 2: Line 2:
 
|Authors=Prajakta.Patil
 
|Authors=Prajakta.Patil
 
|Category=Retina/Vitreous
 
|Category=Retina/Vitreous
|Assigned editor=Vinay.A.Shah.SEC
+
|Assigned editor=Christina.weng
|Reviewer=Prajakta.Patil
+
|Reviewer=Christina.weng
|Date reviewed=June 1, 2017
+
|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
Line 19: Line 18:
 
=== Serous maculopathy associated with optic nerve head pit ===
 
=== Serous maculopathy associated with optic nerve head pit ===
 
'''History:''' Wiethe was the first one to describe this condition in 1882.
 
'''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.
+
'''Clinical Features:''' It is seen as greyish-white excavation in optic nerve head, often in the temporal disc.
 
* Size of the disc is normal
 
* Size of the disc is normal
* Subretinal fluid extending from disc and involving macula
+
* Subretinal fluid extending from disc and involving macula which may wax and wane naturally without intervention
  
  
'''Pathophysiology:''' Subretinal fluid is derived from
+
'''Pathophysiology:''' Subretinal fluid origin is debated, but derivation is thought to be from:
 
* Vitreous
 
* Vitreous
 
* Subarachnoid space
 
* Subarachnoid space
Line 30: Line 29:
  
  
'''Treatment:''' Photocoagulation along temporal margin of the disc with intravitreal gas
+
'''Treatment:'''
* Injection
+
* Observation
* Pars plana vitrectomy with fluid gas exchange with photocoagulation along temporal margin of the disc - more effective
+
* 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 ===
 
=== Serous maculopathy associated with tilted disc syndrome ===
 
'''Clinical Features:'''  
 
'''Clinical Features:'''  
 
* Presence of tilted disc (superotemporal part of optic disc lying anterior to inferonasal part of disc)
 
* 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
+
* Presence of posterior staphyloma with RPE atrophy at the edge of staphyloma
  
  
 
'''Investigations:'''  
 
'''Investigations:'''  
* FFA: multiple pin point leakages at the site of RPE atrophy
+
* FFA: multiple pinpoint leakages at the site of RPE atrophy
 
* OCT: Serous macular detachment
 
* OCT: Serous macular detachment
  
Line 49: Line 54:
  
 
=== Serous maculopathy associated with dysplastic disc ===
 
=== Serous maculopathy associated with dysplastic disc ===
'''Clinical Features:''' Disc dysplasia is abnormally looking disc that does not fit into any other  
+
'''Clinical Features:''' Disc dysplasia, or an abnormally-looking disc that does not fit into any other recognizable category  
* Recognizable category
 
  
  
'''Pathophysiology:''' Could be similar to that of optic nerve head pit
+
'''Pathophysiology:''' Could be similar to that of optic nerve head pit  
'''Management:''' Photocoagulation along temporal margin of disc
+
 
 +
'''Management:''' Photocoagulation along temporal margin of disc has been described
  
 
=== Serous maculopathy associated with optic nerve head coloboma ===
 
=== Serous maculopathy associated with optic nerve head coloboma ===
Line 62: Line 67:
  
 
'''Pathophysiology:''' Subretinal fluid may arise from
 
'''Pathophysiology:''' Subretinal fluid may arise from
* Fluid perfusing into the retrobulbar space from surrounding orbital tissue
+
* Fluid entering into the retrobulbar space from surrounding orbital tissue
 
* Peripapillary choriocapillaris
 
* Peripapillary choriocapillaris
 
* CSF
 
* CSF
  
  
'''Management:''' Photocoagulation along temporal margin of disc
+
'''Management:''' Photocoagulation along temporal margin of disc has been described
  
 
=== Serous maculopathy associated with morning glory syndrome ===
 
=== Serous maculopathy associated with morning glory syndrome ===
 
'''Clinical features:''' Funnel shaped excavation of the posterior pole involving optic disc
 
'''Clinical features:''' Funnel shaped excavation of the posterior pole involving optic disc
* Usually unilateral if bilateral heriditary
+
* Usually unilateral if bilateral hereditary
 
* Serous macular involvement in 30% cases
 
* Serous macular involvement in 30% cases
  
Line 85: Line 90:
  
 
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.