Advanced Visualization Optical Coherence Tomography Imaging Shedding Light on an Atypical Optic Nerve Pit with Maculopathy

Title Advanced Visualization Optical Coherence Tomography Imaging Shedding Light on an Atypical Optic Nerve Pit with Maculopathy
Author, Co-Author Bhawanjot Minhas, Rachel Brackley
Topic Treatment and Management of Posterior Sgmt Disease
Year
2016
Day
Thursday
Program Number
165157
Room
Ballroom A-B
Affiliation
Pennsylvania College of Optometry at Salus University
Abstract

Intro: Optic nerve pits (ONP), a congenital anomaly of the optic disc, are noted 1 in 10,000 eyes with no gender predilection.  Optic pit maculopathy (OPM) is a rare complication characterized by intra or subretinal fluid in the macula.

Case: A 64 yo AA female presented for a glaucoma suspect re-evaluation due to large cupping, race and previous stable inferior temporal (IT) RNFL thinning on OCT. Systemic history included diabetes type II. An OCT prior to follow up indicated retinal edema adjacent to the ONH where previous RNFL thinning had been noted. BCVA was 20/20 OD, OS. IOP was 16 mmHg OU. Dilation revealed a C/D ratio of 0.8/0.85 OD and 0.7/0.7 OS with a subtle optic disc pit IT OD. Juxtapapillary retinal edema following the IT arcade OD was seen clinically, which matched OCT presentation. No diabetic retinopathy was noted OU. Moreover, Advanced Visualization (AV) technology on the Zeiss Cirrus OCT was used to help picture a previously missed atypical optic nerve pit. Evaluation by a retinal specialist ruled out choroid neovascularization (CNV) with fluorescein angiography and an atypical optic pit with adjacent edema and schisis OD was confirmed.

Discussion: ONPs are thought to arise from incomplete closure of the fetal fissure and are most commonly noted IT. Although ONPs are congenital, atypical pits can be missed. In our case, an atypical pit was mistaken for glaucomatous thinning. Complications of OPM alluded to the presence of an ONP as a likely etiology.  Important to rule out is a peripapillary CNV causing retinal edema. AV imaging can be utilized as a novel way to visualize ONPs that are difficult to appreciate clinically. Furthermore, these cases should be followed closely for glaucoma.

Conclusion: A rare consequence of ONPs is OPM. Such cases should be referred to a retinal specialist to rule out neovascularization. Furthermore, our case outlines the use of innovative imaging modalities, such as AV, to help provide insight into atypical cases.

Affiliation of Co-Authors Pennsylvania College of Optometry at Salus University
Outline