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

From EyeWiki
 
(7 intermediate revisions by one other user not shown)
Line 3: Line 3:
 
|Category=Retina/Vitreous
 
|Category=Retina/Vitreous
 
|Assigned editor=Christina.weng
 
|Assigned editor=Christina.weng
|Reviewer=Prajakta.Patil
+
|Reviewer=Christina.weng
|Date reviewed=July 14, 2019
+
|Date reviewed=February 7, 2021
 
|Article status=Up to Date
 
|Article status=Up to Date
 
}}
 
}}
Line 18: 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
  
  
Line 29: Line 29:
  
  
'''Treatment:'''<ref>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
+
'''Treatment:'''   
</ref>  
 
 
* Observation
 
* Observation
 
* Intravitreal gas injection
 
* Intravitreal gas injection
Line 47: Line 46:
  
 
'''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 55: Line 54:
  
 
=== Serous maculopathy associated with dysplastic disc ===
 
=== Serous maculopathy associated with dysplastic disc ===
'''Clinical Features:''' Disc dysplasia, or an 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 74: Line 72:
  
  
'''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 ===

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.