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Rice JC, Scholtz RP, Joseph J. SURGICAL DEMONSTRATION OF PRESSURE DIFFERENTIAL THROUGH AN OPTIC DISK PIT. Retin Cases Brief Rep 2024; 18:337-339. [PMID: 36730593 DOI: 10.1097/icb.0000000000001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/06/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To demonstrate intraoperative dynamic flow through an optic disk pit. METHODS Retrospective interventional case report. RESULTS Surgical management of an optic disk pit involved standard, 25-gauge, pars plana vitrectomy, induction of posterior hyaloid separation with triamcinolone stain, temporal peripapillary laser, and SF 6 gas. Intraoperatively, a remnant of stained vitreous at the optic disk head prolapsed into the optic disk pit with higher intraocular pressure but was drawn back into the vitreous cavity as the intraocular pressure was lowered. This clearly demonstrated a pressure differential across the pit. CONCLUSION Communication between the vitreous cavity and the perineural space of the optic nerve is described histologically. Our case demonstrated dynamic flow through the optic disk pit with intraoperative fluctuation of intraocular pressure.
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Affiliation(s)
- James C Rice
- Department of Ophthalmology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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Cennamo G, Rinaldi M, Concilio M, Costagliola C. Congenital Optic Disc Anomalies: Insights from Multimodal Imaging. J Clin Med 2024; 13:1509. [PMID: 38592429 PMCID: PMC10932420 DOI: 10.3390/jcm13051509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 04/10/2024] Open
Abstract
In this comprehensive review, we delve into the significance of multimodal imaging in diagnosing and managing complications of congenital optic disc anomalies. While the fundus examination is the gold standard tool in the diagnosis of these pathologies, spectral domain (SD) optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) could shed light on the pathogenesis and treatment. Moreover, this review seeks to offer a comprehensive insight into the multimodal approach of these rare congenital pathologies. In conclusion, congenital anomalies of the optic nerve represent a major challenge for ophthalmologists. Further research could be useful to clarify the pathophysiology of these diseases and define a correct and more specific treatment approach.
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Affiliation(s)
- Gilda Cennamo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80138 Napoli, Italy;
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Napoli, Italy
| | - Michele Rinaldi
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80138 Napoli, Italy;
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Napoli, Italy
| | - Marina Concilio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Ciro Costagliola
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80138 Napoli, Italy;
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Orman G, Aydınoglu-Candan O, Sungur G. The prevalance of congenital optic disc anomalies in Turkey: a hospital-based study. Int Ophthalmol 2022; 42:3567-3577. [PMID: 35536457 DOI: 10.1007/s10792-022-02357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/18/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to investigate the prevalence of congenital optic disc anomalies in Turkey. METHODS The 11,123 eyes of 5570 patients were screened for optic disc anomalies. All patients were underwent a complete ophthalmic examination including best corrected visual acuity, refraction, spherical equivalent, slit lamp biomicroscopy, intraocular pressure measurements, dilated stereoscopic fundus examination. Data analyses were performed by using SPSS for Windows, version 22.0 (SPSS Inc., Chicago, IL, United States). RESULTS 11,123 eyes of 5570 participants were screened. Of the 5570 participants who underwent optic disc examination, 246 eyes of 174 patients (3.12%, 95% CIs 2.66-3.58%) had optic disc anormalies. 92 (52.9%) were female, 82 (47.1%) were male and the mean of age was 44.25 ± 15.67 years. 72 (41.4%) patients were bilateral, 102 (58.6%) patients were unilateral involvement. The tilted disc was the most common anomaly and was found at least one eye in 46 patients (75 eyes) and 0.83% of all screened patients. Peripapillary myelinated nerve fibers was the second common anomaly and was found at least one eye in 31 subjects (35 eyes) and 0.56% of all screened subjects. Peripapillary atrophy was the third common anomaly, and was found in at least one eye in 24 patients (37 eyes) and 0.43% of all screened subjects. CONCLUSION To our knowledge, this is the first study that the prevalences of all congenital optic disc anomalies from Turkey. The prevalence of congenital optic disc anomalies is higher than in other countries.
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Affiliation(s)
- Gozde Orman
- Health Science Univercity Ankara Researching and Training Hospital, Departmant of Ophthalmolgy, Ankara, Turkey.
| | - Ozlem Aydınoglu-Candan
- Health Science Univercity Ankara Researching and Training Hospital, Departmant of Ophthalmolgy, Ankara, Turkey
| | - Gulten Sungur
- Health Science Univercity Ankara Researching and Training Hospital, Departmant of Ophthalmolgy, Ankara, Turkey
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Ceylan OM, Yılmaz AC, Durukan AH, Köylü MT, Mutlu FM. A Case of Multiple Optic Disc Pits: 21-Year Follow-up. Turk J Ophthalmol 2021; 51:123-126. [PMID: 33951902 PMCID: PMC8109039 DOI: 10.4274/tjo.galenos.2020.66909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Optic disc pits (ODP) are an uncommon congenital abnormality. Patients remain asymptomatic unless they develop maculopathy. The use of optic coherence tomography has critical benefits in the follow-up of patients who are at the amblyogenic age. The aim of this study is to present a case of double ODP in the right eye and single ODP in the left eye in a partially accommodative esotropia patient followed for 21 years. To our knowledge, multiple ODP has never been described in a patient with partially accommodative esotropia.
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Affiliation(s)
- Osman Melih Ceylan
- University of Health Sciences Turkey Gülhane Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Alper Can Yılmaz
- University of Health Sciences Turkey Gülhane Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Ali Hakan Durukan
- University of Health Sciences Turkey Gülhane Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Mehmet Talay Köylü
- University of Health Sciences Turkey Gülhane Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Fatih Mehmet Mutlu
- University of Health Sciences Turkey Gülhane Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Uzel MM, Karacorlu M. Optic disk pits and optic disk pit maculopathy: A review. Surv Ophthalmol 2019; 64:595-607. [PMID: 30797884 DOI: 10.1016/j.survophthal.2019.02.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 11/19/2022]
Abstract
Optic disk pit, one of the optic disk cavitary anomalies, is generally congenital and unilateral and occurs equally in males and females. Optic disk pit maculopathy is characterized by intraretinal and subretinal fluid at the macula, causing visual deterioration. The origin of the macular fluid and the mechanism of transition to the subretinal space in optic disk pit maculopathy pathophysiology are not yet fully understood. With the evolution of imaging modalities, especially optic coherence tomography, our knowledge of this disorder continues to increase. Although many different treatments have been tried, there is no consensus on the most effective.
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Steel DHW, Suleman J, Murphy DC, Song A, Dodds S, Rees J. Optic Disc Pit Maculopathy: A Two-Year Nationwide Prospective Population-based Study. Ophthalmology 2018; 125:1757-1764. [PMID: 29887331 DOI: 10.1016/j.ophtha.2018.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/02/2018] [Accepted: 05/07/2018] [Indexed: 10/14/2022] Open
Abstract
PURPOSE To identify the incidence, presenting features, treatment, and clinical course of optic disc pit maculopathy (ODPM) in the United Kingdom (UK). DESIGN A 2-year nationwide prospective population-based study. SUBJECTS All new incident cases of ODPM presenting to UK ophthalmologists using the British Ophthalmic Surveillance Unit monthly reporting system. METHODS All reporting ophthalmologists were sent an initial questionnaire requesting data on previous medical and ophthalmic history, presentation details, investigation findings, and management. A further questionnaire was sent at 12 months post diagnosis to ascertain further outcome data. MAIN OUTCOME MEASURES Visual acuity at initial presentation, at 1 year, and after any intervention. Foveal involvement and optical coherence tomography (OCT) findings, including retinal layers affected, and the location and size of the optic disc pit. Management, including observation, vitrectomy, and associated procedures. RESULTS There were 74 confirmed new cases, giving an annual incidence of approximately 1 per 2 million. Complete data were available on 70 patients (70 eyes) at baseline and 68 after 1 year. There were 35 (50%) female patients with a mean age of 35 years (range, 3-82 years). Visual acuity at baseline ranged from 6/5 to hand movements. In 43 patients (61%) subretinal fluid (SRF) was present, whereas 27 (39%) had intraretinal fluid only. The presence of SRF was associated with worse vision and foveal involvement. Of the 53 eyes initially observed with 1-year follow-up, 10 (19%) deteriorated and 9 (16%) improved on OCT; eyes with SRF were more likely to worsen and those without SRF were more likely to improve. Fifteen of the 70 patients (21%) at baseline had primary surgery and a further 10 had deferred surgery within 1 year of presentation; 19 of these 25 eyes (76%) showed anatomic success with a dry fovea at 1 year of follow-up, and 15 (60%) had a greater than 0.1 logMAR improvement in visual acuity. CONCLUSION The incidence and presenting features of ODPM were defined. Patients with SRF had worse vision and were more likely to deteriorate than patients with intraretinal fluid only. Surgery was anatomically successful in 75% of cases. Patients without SRF tended to remain stable with observation.
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Affiliation(s)
- David H W Steel
- Sunderland Eye Infirmary, Sunderland, United Kingdom; Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom.
| | - Javid Suleman
- Sunderland Eye Infirmary, Sunderland, United Kingdom
| | - Declan C Murphy
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Anna Song
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Steve Dodds
- Sunderland Eye Infirmary, Sunderland, United Kingdom
| | - Jon Rees
- School of Psychology, Faculty of Health Sciences and Well Being, University of Sunderland, Sunderland, United Kingdom
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Role of the Epipapillary Membrane in Maculopathy Associated with Cavitary Optic Disc Anomalies: Morphology, Surgical Outcomes, and Histopathology. J Ophthalmol 2018; 2018:5680503. [PMID: 29854427 PMCID: PMC5964424 DOI: 10.1155/2018/5680503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/15/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the surgical outcomes of pars plana vitrectomy (PPV) with epipapillary membrane removal in patients with maculopathy associated with cavitary optic disc anomalies. Methods Eight patients (8 eyes) with cavitary optic disc anomaly-associated maculopathy who underwent PPV with epipapillary membrane removal were retrospectively reviewed. The best-corrected visual acuity (BCVA) and macular and papillary morphologies using enhanced depth imaging optical coherence tomography (EDI-OCT) were evaluated before and after treatment. Immunohistochemistry for an intraoperatively excised epipapillary membrane tissue was also performed. Results Before surgery, EDI-OCT revealed that epipapillary membrane was observed in all patients. Retinoschisis was resolved with no recurrence in all patients following vitrectomy regardless of a disease type or the presence or absence of preoperative posterior vitreous detachment. The mean final BCVA and central retinal thickness significantly improved compared with pretreatment values (P = 0.008 and 0.004, resp.). Immunoreactivity for S100 protein and glial fibrillary acidic protein, markers of astrocytes, was positive in the resected membrane tissues. Conclusions These results suggest that epipapillary membrane is involved in the pathogenesis of some patients with cavitary optic disc anomaly-associated maculopathy as well as posterior hyaloid membrane. PPV with epipapillary membrane removal may be a useful treatment option for this maculopathy. This trial is registered with UMIN000011123.
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Maertz J, Kolb JP, Klein T, Mohler KJ, Eibl M, Wieser W, Huber R, Priglinger S, Wolf A. Combined in-depth, 3D, en face imaging of the optic disc, optic disc pits and optic disc pit maculopathy using swept-source megahertz OCT at 1050 nm. Graefes Arch Clin Exp Ophthalmol 2017; 256:289-298. [PMID: 29238852 PMCID: PMC5790839 DOI: 10.1007/s00417-017-3857-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 10/25/2017] [Accepted: 11/21/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To demonstrate papillary imaging of eyes with optic disc pits (ODP) or optic disc pit associated maculopathy (ODP-M) with ultrahigh-speed swept-source optical coherence tomography (SS-OCT) at 1.68 million A-scans/s. To generate 3D-renderings of the papillary area with 3D volume-reconstructions of the ODP and highly resolved en face images from a single densely-sampled megahertz-OCT (MHz-OCT) dataset for investigation of ODP-characteristics. Methods A 1.68 MHz-prototype SS-MHz-OCT system at 1050 nm based on a Fourier-domain mode-locked laser was employed to acquire high-definition, 3D datasets with a dense sampling of 1600 × 1600 A-scans over a 45° field of view. Six eyes with ODPs, and two further eyes with glaucomatous alteration or without ocular pathology are presented. 3D-rendering of the deep papillary structures, virtual 3D-reconstructions of the ODPs and depth resolved isotropic en face images were generated using semiautomatic segmentation. Results 3D-rendering and en face imaging of the optic disc, ODPs and ODP associated pathologies showed a broad spectrum regarding ODP characteristics. Between individuals the shape of the ODP and the appending pathologies varied considerably. MHz-OCT en face imaging generates distinct top-view images of ODPs and ODP-M. MHz-OCT generates high resolution images of retinal pathologies associated with ODP-M and allows visualizing ODPs with depths of up to 2.7 mm. Conclusions Different patterns of ODPs can be visualized in patients for the first time using 3D-reconstructions and co-registered high-definition en face images extracted from a single densely sampled 1050 nm megahertz-OCT (MHz-OCT) dataset. As the immediate vicinity to the SAS and the site of intrapapillary proliferation is located at the bottom of the ODP it is crucial to image the complete structure and the whole depth of ODPs. Especially in very deep pits, where non-swept-source OCT fails to reach the bottom, conventional swept-source devices and the MHz-OCT alike are feasible and beneficial methods to examine deep details of optic disc pathologies, while the MHz-OCT bears the advantage of an essentially swifter imaging process. Electronic supplementary material The online version of this article (10.1007/s00417-017-3857-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Josef Maertz
- Augenklinik der Ludwig-Maximilians-Universität München, Campus Innenstadt, Mathildenstraße 8, D-80336, Munich, Germany
| | - Jan Philip Kolb
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Munich, Germany
- Institut für Biomedizinische Optik, Universität zu Lübeck, Lübeck, Germany
| | - Thomas Klein
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kathrin J Mohler
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Matthias Eibl
- Institut für Biomedizinische Optik, Universität zu Lübeck, Lübeck, Germany
| | - Wolfgang Wieser
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Robert Huber
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Munich, Germany
- Institut für Biomedizinische Optik, Universität zu Lübeck, Lübeck, Germany
| | - Siegfried Priglinger
- Augenklinik der Ludwig-Maximilians-Universität München, Campus Innenstadt, Mathildenstraße 8, D-80336, Munich, Germany
| | - Armin Wolf
- Augenklinik der Ludwig-Maximilians-Universität München, Campus Innenstadt, Mathildenstraße 8, D-80336, Munich, Germany.
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Wehrmann K, Stumpfe S, Pettenkofer M, Feucht N, Lohmann C, Maier M. [Maculopathy with optic nerve pits : Morphological criteria in SD-OCT]. Ophthalmologe 2017; 115:216-221. [PMID: 28405756 DOI: 10.1007/s00347-017-0490-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Optic pit is a congenital anomaly with malformation similar to coloboma of the optic disc. The cause of optic pit maculopathy is controversial. We used high resolution OCT to investigate changes in the vitreoretinal and vitreopapillary transition within optic pit eyes. METHODS The vitreoretinal and vitreo-papillary transition of 12 eyes was accurately analyzed using SD-OCT. We registered the following criteria: liquefaction of prepapillary vitreous, papillary vitreous traction, discontinuity within the hyaloid cortex and communication spaces between pit and retinal edema. RESULTS Communication gaps between pit and retinal edema were identified in 8 eyes. 4 eyes had a papillary vitreous traction. 4 showed a discontinuity in the hyaloid cortex. 2 of the 12 patients showed no maculopathy in SD-OCT. Those patients had an adjacent papillary vitreous without prepapillary liquefaction. However all eyes showed vitreous liquefaction at some stage premacullary or prepapillary. CONCLUSION Yet the cause of optic pit maculopathy is not clearly understood. High resolution OCT imaging provides a very detailed assessment of the vitreoretinal transition prepapillary and premacullary, however with limited penetration depth and analyzation of deeper lying structures. Our observations suggest that prepapillary liquefaction and pressure gradients within cerebrospinal and intraokular pressure could be key factors.
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Affiliation(s)
- K Wehrmann
- Augenklinik, Klinikum rechts der Isar, TU München, Ismaningerstrasse 22, 81675, München, Deutschland.
| | - S Stumpfe
- Augenklinik, Klinikum rechts der Isar, TU München, Ismaningerstrasse 22, 81675, München, Deutschland
| | - M Pettenkofer
- Augenklinik, Klinikum rechts der Isar, TU München, Ismaningerstrasse 22, 81675, München, Deutschland
| | - N Feucht
- Augenklinik, Klinikum rechts der Isar, TU München, Ismaningerstrasse 22, 81675, München, Deutschland
| | - C Lohmann
- Augenklinik, Klinikum rechts der Isar, TU München, Ismaningerstrasse 22, 81675, München, Deutschland
| | - M Maier
- Augenklinik, Klinikum rechts der Isar, TU München, Ismaningerstrasse 22, 81675, München, Deutschland
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