Optic Disk Pit with Sudden Central Visual Field Scotoma The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters. Citation Published Version Accessed Citable Link Terms of Use Panou, Nikol, and Demetrios G. Vavvas. 2016. Optic Disk Pit with Sudden Central Visual Field Scotoma. Case Reports in Ophthalmological Medicine 2016 (1): 1423481. doi:10.1155/2016/1423481. http://dx.doi.org/10.1155/2016/1423481. doi:10.1155/2016/1423481 April 12, 2018 9:47:36 AM EDT http://nrs.harvard.edu/urn-3:hul.instrepos:6001 This article was downloaded from Harvard University's DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:hul.instrepos:dash.current.termsof-use#laa (Article begins on next page)
Hindawi Publishing Corporation Case Reports in Ophthalmological Medicine Volume 2016, Article ID 1423481, 4 pages http://dx.doi.org/10.1155/2016/1423481 Case Report Optic Disk Pit with Sudden Central Visual Field Scotoma Nikol Panou 1 and Demetrios G. Vavvas 2,3,4,5 1 Ophthalmic Clinic, General Oncologic Hospital Agioi Anargyroi, Kaliftaki, N. Kifissia, 14564 Attiki, Greece 2 MonteJ.WallaceOphthalmologyChairinRetina,Boston,MA,USA 3 HarvardMedicalSchool,Boston,MA,USA 4 Ocular Regenerative Medical Institute, Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital, 243 Charles St., Boston, MA 02114, USA 5 Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital, 243 Charles St., Boston, MA 02114, USA Correspondence should be addressed to Nikol Panou; nikolpanou@yahoo.gr Received 18 July 2016; Revised 1 September 2016; Accepted 8 September 2016 Academic Editor: Hsin-Yi Chen Copyright 2016 N. Panou and D. G. Vavvas. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. To describe a case of optic disk pit (ODP) with sudden central visual field scotoma. Methods. A 49-year-old woman presented, reporting sudden painless central visual field loss 3 months prior to presentation. Neuroophthalmologic, systematic, and laboratory evaluation and full imaging processes were performed. Results. Fundoscopy and color photography demonstrated an optic disk pit inferotemporally. Perimetry identified central visual field horizontal scotoma. OCT revealed absence of serous retinal detachment, but disclosed inner retina thinning corresponding to the area of the visual field loss. Fluorescein angiography demonstrated delay in the cilioretinal arteries and also disclosed a relative delay in the perfusion of an arterial branch off the inferior retinal arcade. Clinical and laboratory evaluations were negative for any related pathology. Conclusion. Sudden central visual field scotoma in patients with ODP may be associated with delayed vascular filling of CRA and retinal arterioles within the optic disc anomaly region. 1. Introduction Optic nerve pits have originally been described by Wiethe in 1882 as congenital excavations of the optic nerve [1]. In 1958, Petersen [2] reported that congenital optic nerve pits may be complicated by serous maculopathy. In 1978, Radius et al. noted the appearance of acquired optic pits in the progress of open-angle glaucoma [3]. Both congenital and acquired pits canbeassociatedwithvisualfielddefects. 2. Case Presentation A 49-year-old woman presented, reporting annoying, horizontal, bar-like positive scotoma, which suddenly appeared 3 months ago on the left eye. The visual acuity overall had remained stable. Neuroophthalmologic as well as systemic and laboratory evaluation failed to reveal any evidence of related pathology. A full ophthalmic imaging process was performed. Humphrey 24-2 visual field examination demonstrated central, horizontal visual field scotoma (Figure 1). Theintraocularpressurewasnormalandthesameinboth eyes. Fundus examination and color photography revealed ODP inferotemporally, associated with a dark nerve fiber area. OCT confirmed absence of serous retinal detachment, but focal nerve fiber loss in correspondence with the dark nerve fiber area (Figure 2). The CRA was not filled until.3 seconds after injection (Figure 3). In addition, a delay in the perfusion of an arterial branch off the inferior retinal arcade was noted. There was a corresponding area of inner retinal thinning on OCT over the area of vascular filling delay.
2 Case Reports in Ophthalmological Medicine Central 24-2 Threshold Test Fixation monitor: blind spot Fixation target: central Fixation losses: 12/13 xx False POS errors: 16% xx False NEG errors: % Test duration: 04:52 Stimulus: III, white Pupil diameter: Date: 09--2009 Background: 31.5 ASB Visual acuity: Time: 7:42 a.m. Strategy: SITA-fast RX: DS Age: 49 DC X Fovea: off 19 31 24 23 24 5 <0 14 12 22 0 23 20 2 2 1 1 4 1 4 4 4 1 3 4 3 4 5 5 5 10 1 5 7 10 9 6 8 2 9 35 19 20 7 8 0 6 3 3 3 3 2 3 1 3 2 2 4 5 2 2 1 0 Total 1 0 1 0 3 0 2 2 3 0 2 2 2 3 3 4 3 9 2 4 6 8 7 5 7 1 7 34 17 19 6 7 1 5 2 2 2 1 1 2 0 2 1 1 2 3 0 1 0 1 Pattern Excessive high false positive GHT Outside normal limits MD 6.49 db P < 0.5% PSD 7.91 db P<0.5% <5% <2% <1% <0.5% Neuro-Ophthalmology Unit Massachusetts Eye and Ear Infirmary 243 Charles St. Boston, MA 02114 617-573-3412 Central 24-2 Threshold Test Fixation monitor: blind spot Fixation target: central Fixation losses: 0/11 False POS errors: 0% False NEG errors: 0% Test duration: 03:08 Stimulus: III, white Pupil diameter: Date: 09--2009 Background: 31.5 ASB Visual acuity: Time: 7:37 a.m. Strategy: SITA-fast RX: DS Age: 49 DC X Fovea: off 24 22 17 21 31 31 18 31 4 21 31 31 1 3 3 4 3 2 2 4 1 0 7 4 5 2 11 10 4 5 3 7 5 3 3 2 1 4 4 5 3 2 2 3 1 2 4 0 3 3 6 1 6 4 0 2 1 3 2 1 1 2 0 1 6 3 4 1 2 2 0 1 10 8 3 4 1 1 2 1 6 3 2 2 1 1 2 0 2 3 3 3 2 4 5 3 GHT Outside normal limits 2 2 5 3 3 4 3 3 1 2 Total Pattern 0 1 4 1 1 2 1 2 0 1 MD PSD 3. db P<1% 2.08 db P<5% <5% <2% <1% <0.5% Neuro-Ophthalmology Unit Massachusetts Eye and Ear Infirmary 243 Charles St. Boston, MA 02114 617-573-3412 Figure 1: 24-2 Threshold Test, Humphrey Visual Field Analysis. Central scotoma of the left eye and the right eye.
Case Reports in Ophthalmological Medicine 3 Gender: female Physician: Technician: operator, cirrus Signal strength: 9/10 Macular thickness: macular cube 512 1 OD OS 9 7 8 0 181 312 249 324 4 ILM-RPE thickness (μm) Overlay: OCT fundus Transparency: 21% ILM Gender: female Physician: Technician: operator, cirrus Signal strength: 9/10 Macular thickness: macular cube 512 1 OD OS 4 351 362 7 196 8 7 0 3 ILM-RPE thickness (μm) Overlay: OCT fundus Transparency: 21% ILM Figure 2: Spectral domain OCT centered on the optic nerve. Right eye. Left eye showing nerve fiber loss inferotemporally of the optic disk.
4 Case Reports in Ophthalmological Medicine Figure 3: Fluorescein angiography showing delay of cilioretinal artery filling and a relative delay of the inferior branch retinal arteriole. Filling of the retinal arterial system but not of the cilioretinal artery by 21.2 seconds. Full filling of the CRA at.3 seconds. 3. Discussion Usually patients with congenital optic pits may remain asymptomatic until complicated by serous macular schisis and detachment in their s or 40s [4]. In this case, no subretinal fluid schisis or detachment was identified. There is a single small series study by Adelung et al. [5] describing scotomas in patients with optic disk pit without subretinal fluid, also accompanied by defect in the nerve fiber layer, but no evidence of vascular blood flow as detected by FA was reported. Glaucomatous visual field loss close to fixation in acquired pits of the optic nerve has been more frequently associated with lower pressures [6]. Our patient s visual field defect did not have glaucomatous characteristics and for this reason a vascular cause was investigated via fluorescein angiography. FA demonstrated delayed vascular filling in the area of OCT thickness loss and corresponding visual field loss. Vascular occlusion has not been previously reported in conjunction with optic disc pit, although optic disk pits have been associated with retinal venous anastomoses [7]. [5] K. Adelung, E. Aulhorn, and H. J. Thiel, Disorders of function in pitting of the optic disk, Klinische Monatsblätter für Augenheilkunde,vol.191,no.1,pp.1 8,1987. [6] C. Nduaguba, S. Ugurlu, and J. Caprioli, Acquired pits of the optic nerve in glaucoma: prevalence and associated visual field loss, Acta Ophthalmologica Scandinavica, vol. 76, no. 3, pp. 3 7, 1998. [7] G. P. Theodossiadis, A. G. Damanakis, and P. G. Theodossiadis, Coloboma of the optic disk associated with retinal vascular abnormalities, American Journal of Ophthalmology,vol.120,no. 6, pp. 798 800, 1995. Competing Interests The authors declare that there are no competing interests regarding the publication of this manuscript. References [1] T. Wiethe, Ein fail von angeborener difformitat der schnervenpapille, Arch F Augenheilkd,vol.11,pp.14 19,1882. [2] H. P. Petersen, Pits or crater-like holes in the optic disc, Acta Ophthalmologica,vol.36,no.3,pp.435 443,1958. [3] R. L. Radius, A. E. Maumenee, and W. R. Green, Pit-like changes of the optic nerve head in open-angle glaucoma, British Journal of Ophthalmology, vol.62,no.6,pp.389 393, 1978. [4] I.Georgalas,I.Ladas,G.Georgopoulos,andP.Petrou, Optic disc pit: a review, Graefe s Archive for Clinical and Experimental Ophthalmology, vol. 249, no. 8, pp. 1113 1122, 2011.