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Retinal Tears and Detachments
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Non rhegmatogenous retinal detachments: This can be due to a range of diseases described below: Inflammatory disease: Such as Vogt–Koyanagi–Harada (VKH) syndrome, posterior scleritis and other chronic inflammatory processes. This traditionally causes multiple serous detachments.Neoplasia: Choroidal melanoma, metastasis, choroidal haemangioma, multiple myeloma, capillary retinal haemangioma can all present with exudative retinal detachments.Congenital abnormalities: Optic pits, morning-glory syndrome and choroidal coloboma may also present with detachment of the neuro-sensory retina.Vascular: Coats’ disease and malignant hypertension both have exudative retinal detachments.Ocular hypotension: Glaucoma drainage surgery may result in choroidal detachments which can mimic retinal detachments. If the choroidal detachments are not touching they can often resolve once the intraocular pressure has been re-established.
Miscellaneous conditions
Published in Thomas H. Williamson, Vitreoretinal Disorders in Primary Care, 2017
This severe optic disc anomaly can be associated with posterior polar RD or schisis in as many as 35% of patients.29 Often vision is poor because of the disc abnormality, and there is nystagmus. A communication has been described between the subarachnoid space30 and the subretinal space (metrizamide cisterography has shown dye migration into the SRF). More commonly, a hole on the optic nerve head has been blamed for the passage of fluid from the vitreous cavity to the subretinal space in a similar fashion to optic pit. For this reason, vitrectomy has been used with peripapillary laser applied to block the flow of fluid and with internal tamponade (Figure 11.6).
Optic nerve
Published in Fiona Rowe, Visual Fields via the Visual Pathway, 2016
This relatively common condition consists of a round or oval pit which appears darker than the surrounding disc tissue (Brown 1980). The location is most frequently unilateral (Healey and Mitchell 2008) and infero-temporal on the optic disc (Figure 6.5). About 50% of eyes with congenital optic pits develop oedema or a serous detachment of the macula. This can mimic central serous chorioretinopathy.
Stellate nonhereditary idiopathic foveomacular retinoschisis in an asymptomatic patient
Published in Clinical and Experimental Optometry, 2022
Thomas A Keith, Megan C Mills, Eric Tidmore
Foveal retinoschisis has previously been associated with conditions causing structural compromise to the macula such as myopic degeneration, staphyloma, optic pit maculopathy, glaucoma, degenerative or acquired retinoschisis, epiretinal membrane, and vitreomacular traction. Likewise, toxic triggers from niacin and taxane-derived pharmaceuticals can cause cystic spaces to form in the outer plexiform layer and inner nuclear layer and should be ruled out as a differential.1 The patient in the present study was only moderately myopic, and posterior staphyloma was not observed. This patient did not have an optic pit or any findings indicative of glaucoma. Large smooth, domed-shaped elevation of the peripheral retina, as seen in degenerative retinoschisis, was not observed. The characteristic stellate foveal splitting of the Henle fibre layer in SNIFR helped to rule out epiretinal membrane and vitreomacular traction as the primary diagnosis. Additionally, the patient was not taking niacin and taxane-derived medications.
Long‐term stability of an asymptomatic optic pit with foveolar retinoschisis
Published in Clinical and Experimental Optometry, 2020
Best‐corrected visual acuity was 6/6 for both right and left eyes. Dilated fundus examination was unremarkable for the left eye. In the right eye, a temporally located optic pit with a contiguous schisis extended to the macular zone with a central foveolar schisis. The fundus appearance was identical to the description 10-years earlier (Figure 1). A Humphrey visual field was essentially normal in the affected eye (Figure 2). Spectral domain optical coherence tomography detailed the schisis zone which emanated adjacent to the optic pit border and extended to the macular area. At the macular centre the characteristic foveolar schisis pattern could be observed encompassing the outer plexiform layer and to a lesser extent involved the inner nuclear layer. However, there was no underlying central serous detachment. The optic pit was visible with an apparent tubular canal covering the anterior‐posterior width of the optic nerve. The peripapillary posterior vitreous face was similarly observed still attached proximal to the optic nerve head and within the macular zone (Figures 3).
Congenital cavitary optic disc anomaly and Axenfeld’s anomaly in Wolf-Hirschhorn syndrome: A case report and review of the literature
Published in Ophthalmic Genetics, 2018
Mohsin H. Ali, Nathalie F. Azar, Vinay Aakalu, Felix Y. Chau, Javaneh Abbasian, Pete Setabutr, Irene H. Maumenee
The appearance of the optic nerves in this patient is unusual, and characterized by a large disc diameter (megalopapillae), deep excavation, circumferential enlargement of the cup-to-disc ratio with neuroretinal rim narrowing, and seemingly absent central retinal vessels with vessels located at the edge of the optic discs. The distribution and appearance of the retinal vessels suggest a rarely described “vacant disc” appearance. The vacant disc has been previously described as a normal-sized disc with absent central retinal vessels and an exclusively cilioretinal vascular supply, and may be associated with renal abnormalities (papillorenal syndrome) (10). Although this patient had bilateral renal hypoplasia and optic nerves reminiscent of the vacant disc, megalopapilla is not considered to be a feature of the vacant disc. In other cases of Wolf-Hirschhorn syndrome, the appearance of the optic nerve has been variably described as megalopapilla, optic nerve coloboma, morning glory disc anomaly, dysplastic, and glaucomatous (4,5). We hypothesize that the optic nerve findings in some prior reports of Wolf-Hirschhorn syndrome may be referring to the same or a similar phenotypic manifestation with differing terminology. For this reason, we have chosen to use a broader term, congenital cavitary optic disc anomaly (11), to describe the optic nerve appearance because it encompasses features that resemble optic pit, optic nerve coloboma, megalopapilla, vacant disc, and morning glory disc anomaly. The photographs depicted here represent, to our knowledge, the first published photodocumentation of this optic disc appearance in Wolf-Hirschhorn syndrome. We anticipate that these photographs may serve as reference photographs for other patients with Wolf-Hirschhorn syndrome and similar congenital optic nerve findings and may allow for standardized terminology.