Case Report Optic Disk Pit with Sudden Central Visual Field Scotomadownloads.hindawi.com/journals/criopm/2016/1423481.pdf · 2019-07-30 · Purpose . To describe a case of optic disk

Case ReportOptic Disk Pit with Sudden Central VisualField Scotoma

Nikol Panou1 and Demetrios G. Vavvas2,3,4,5

1Ophthalmic Clinic, General Oncologic Hospital “Agioi Anargyroi”, Kaliftaki, N. Kifissia, 14564 Attiki, Greece2Monte J. Wallace Ophthalmology Chair in Retina, Boston, MA, USA3Harvard Medical School, Boston, MA, USA4Ocular Regenerative Medical Institute, Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital, 243 Charles St.,Boston, MA 02114, USA5Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital, 243 Charles St., Boston,MA 02114, USA

Correspondence should be addressed to Nikol Panou; [email protected]

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 AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.

Purpose. To describe a case of optic disk pit (ODP) with sudden central visual field scotoma. Methods. A 49-year-old womanpresented, 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 demonstratedan optic disk pit inferotemporally. Perimetry identified central visual field horizontal scotoma. OCT revealed absence of serousretinal detachment, but disclosed inner retina thinning corresponding to the area of the visual field loss. Fluorescein angiographydemonstrated delay in the cilioretinal arteries and also disclosed a relative delay in the perfusion of an arterial branch off the inferiorretinal arcade. Clinical and laboratory evaluations were negative for any related pathology. Conclusion. Sudden central visual fieldscotoma in patients with ODP may be associated with delayed vascular filling of CRA and retinal arterioles within the optic discanomaly region.

1. Introduction

Optic nerve pits have originally been described by Wiethe in1882 as congenital excavations of the optic nerve [1]. In 1958,Petersen [2] reported that congenital optic nerve pits maybe complicated by serous maculopathy. In 1978, Radius et al.noted the appearance of acquired optic pits in the progress ofopen-angle glaucoma [3]. Both congenital and acquired pitscan be associated with visual field defects.

2. Case Presentation

A 49-year-old woman presented, reporting annoying, hori-zontal, bar-like positive scotoma, which suddenly appeared3 months ago on the left eye. The visual acuity overall had

remained stable. Neuroophthalmologic as well as systemicand laboratory evaluation failed to reveal any evidence ofrelated pathology. A full ophthalmic imaging process wasperformed. Humphrey 24-2 visual field examination demon-strated central, horizontal visual field scotoma (Figure 1).The intraocular pressure was normal and the same in botheyes. Fundus examination and color photography revealedODP inferotemporally, associated with a dark nerve fiberarea. OCT confirmed absence of serous retinal detachment,but focal nerve fiber loss in correspondence with the darknerve fiber area (Figure 2). The CRA was not filled until 25.3seconds after injection (Figure 3). In addition, a delay in theperfusion of an arterial branch off the inferior retinal arcadewas noted. There was a corresponding area of inner retinalthinning on OCT over the area of vascular filling delay.

Hindawi Publishing CorporationCase Reports in Ophthalmological MedicineVolume 2016, Article ID 1423481, 4 pageshttp://dx.doi.org/10.1155/2016/1423481

2 Case Reports in Ophthalmological Medicine

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Neuro-Ophthalmology UnitMassachusetts Eye and Ear Infirmary243 Charles St.Boston, MA 02114617-573-3412

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Neuro-Ophthalmology UnitMassachusetts Eye and Ear Infirmary243 Charles St.Boston, MA 02114617-573-3412

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Figure 1: 24-2 Threshold Test, Humphrey Visual Field Analysis. Central scotoma of the left eye (a) and the right eye (b).

Case Reports in Ophthalmological Medicine 3

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Figure 2: Spectral domain OCT centered on the optic nerve. (a) Right eye. (b) Left eye showing nerve fiber loss inferotemporally of the opticdisk.

4 Case Reports in Ophthalmological Medicine

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Figure 3: Fluorescein angiography showing delay of cilioretinal artery filling and a relative delay of the inferior branch retinal arteriole. (a)Filling of the retinal arterial system but not of the cilioretinal artery by 21.2 seconds. (b) Full filling of the CRA at 25.3 seconds.

3. Discussion

Usually patients with congenital optic pits may remainasymptomatic until complicated by serous macular schisisand detachment in their 30s or 40s [4]. In this case, nosubretinal fluid schisis or detachment was identified. Thereis a single small series study by Adelung et al. [5] describingscotomas in patients with optic disk pit without subretinalfluid, also accompanied by defect in the nerve fiber layer, butno evidence of vascular blood flow as detected by FA wasreported.

Glaucomatous visual field loss close to fixation inacquired pits of the optic nerve has been more frequentlyassociated with lower pressures [6]. Our patient’s visual fielddefect did not have glaucomatous characteristics and forthis reason a vascular cause was investigated via fluoresceinangiography. FA demonstrated delayed vascular filling in thearea of OCT thickness loss and corresponding visual fieldloss. Vascular occlusion has not been previously reported inconjunction with optic disc pit, although optic disk pits havebeen associated with retinal venous anastomoses [7].

Competing Interests

The authors declare that there are no competing interestsregarding the publication of this manuscript.

References

[1] T.Wiethe, “Ein fail von angeborener difformitat der schnerven-papille,” Arch F Augenheilkd, vol. 11, pp. 14–19, 1882.

[2] H. P. Petersen, “Pits or crater-like holes in the optic disc,” ActaOphthalmologica, vol. 36, no. 3, pp. 435–443, 1958.

[3] R. L. Radius, A. E. Maumenee, and W. R. Green, “Pit-likechanges 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, and P. Petrou, “Opticdisc pit: a review,”Graefe’s Archive for Clinical and ExperimentalOphthalmology, vol. 249, no. 8, pp. 1113–1122, 2011.

[5] K. Adelung, E. Aulhorn, and H. J. Thiel, “Disorders of functionin pitting of the optic disk,” Klinische Monatsblatter fur Augen-heilkunde, vol. 191, no. 1, pp. 1–8, 1987.

[6] C. Nduaguba, S. Ugurlu, and J. Caprioli, “Acquired pits of theoptic nerve in glaucoma: prevalence and associated visual fieldloss,”ActaOphthalmologica Scandinavica, vol. 76, no. 3, pp. 273–277, 1998.

[7] G. P. Theodossiadis, A. G. Damanakis, and P. G.Theodossiadis,“Coloboma of the optic disk associated with retinal vascularabnormalities,”American Journal ofOphthalmology, vol. 120, no.6, pp. 798–800, 1995.

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Case Report Optic Disk Pit with Sudden Central Visual Field Scotomadownloads.hindawi.com/journals/criopm/2016/1423481.pdf · 2019-07-30 · Purpose . To describe a case of optic disk