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Impressum
Optical Coherence Tomography (OCT) in Optic Pit - Case Report
Hörle S., Kroll P.
Department of Ophthalmology, Philipps-Universität, Robert-Koch-Str. 4, D-35037 Marburg
Introduction: Optic pits were first described by Wiethe in 1882.
They are rare congenital anomalies of the optic nerve going along with
a detachment of neurosensory retina in the macula in 30-50% and a schisis-like
inner layer separation at the posterior pole (ILS).
Case report: A 31-year-old female patient complained of a reduction
of visual acuity to 0.2 and blurred vision of the right eye. She had been
diagnosed with an optic pit and a fluorescein angiogram had been performed
elsewhere to rule out a serous maculopathy. OCT showed a detachment of
neurosensory retina in the macular area as well as an ILS without visible
connection of the two. We performed pars plana vitrectomy, a three weeks
gas endotamponade and endolasercoagulation temporal to the optic nerve
head. Visual acuity increased slightly, but ILS and detachment of the
neurosensory retina persisted 3 months postoperatively.
Discussion: In 1988 Lincoff and coworkers postulated, that ILS
preceded the posterior pole neurosensory retinal detachment, thus suggesting
the opposite of predominating scientific opinion at the time. Intraretinal
fluid possibly originates in the orbit, getting into the optic pit via
a fenestration of the optic nerve, and thus leading to ILS and secondarily
to neurosensory detachment - possibly due to pigment epithelium insufficiency
(Rutledge 1996). According to their suggestion it is unlikely, that intraretinal
fluid originates in the vitreous or in cerebrospinal fluid. Therefore,
intraocular tamponade and lasercoagulation each seem to be only temporarily
successful. Even the above case treated by pars plana vitrectomy and relatively
long acting intraocular tamponade combined with endolasercoagulation did
not improve much. Possibly, silicone oil might be required as long acting
tamponade combined with laser treatment to lead to a constant closure
of ILS and reattachment of neurosensory retina.