Korean J Ophthalmol.  2011 Dec;25(6):455-458. 10.3341/kjo.2011.25.6.455.

Optic Disc Pit with Peripapillary Retinoschisis Presenting as a Localized Retinal Nerve Fiber Layer Defect

• Song IS
• Shin JW
• Shin YW
• Uhm KB

• KMID: 1031196
• DOI: http://doi.org/10.3341/kjo.2011.25.6.455

Abstract

A 59-year-old woman was referred to our clinic for a glaucoma evaluation. The visual acuity and intraocular pressure were normal in both eyes. However, red-free fundus photography in the left eye showed a superotemporal wedge-shaped retinal nerve fiber layer defect, and visual field testing showed a corresponding partial arcuate scotoma. In an optical coherence tomography examination, the macula was flat, but an arcuate-shaped peripapillary retinoschisis was found. Further, the retinoschisis seemed to be connected with a superotemporal optic pit shown in a disc photograph. After 3 months of a topical prostaglandin analogue medication, the intraocular pressure in the retinoschisis eye was lowered from 14 to 10 mmHg and the peripapillary retinoschisis was almost resolved. We report a rare case of an optic disc pit with peripapillary retinoschisis presenting as a localized retinal nerve fiber layer defect.

Keyword

Glaucoma; Optic disc; Retinoschisis

MeSH Terms

Female
Humans
Middle Aged
Nerve Fibers/*pathology
Optic Disk/*abnormalities/*pathology
Optic Nerve Diseases/*diagnosis
Retinal Ganglion Cells/*pathology
Retinoschisis/*diagnosis/drug therapy
Tomography, Optical Coherence

Figure

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  Fig. 1 (A) Disc photography showing a round, gray, superotemporal optic disc pit (black arrow) in the left eye. (B) Red-free fundus photography. The superotemporal wedge-shaped retinal nerve fiber layer defect is shown (white arrow). (C) An infrared laser ophthalmoscope image shows the optic disc pit more clearly (white arrow). (D) After 3 months of a topical prostaglandin analogue medication, the retinal nerve fiber layer defect seems to have decreased (white arrow).

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  Fig. 2 (A) Humphrey visual field testing in the left eye showed the inferior partial arcuate scotoma corresponding with the superotemporal retinal nerve fiber layer defect. (B) After 3 months of topical prostaglandin analogue medication, there was no change in the results of visual field testing.

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  Fig. 3 (A) An optical coherence tomography retinal nerve fiber layer scan in the left eye demonstrated retinal nerve fiber layer (RNFL) thickening of the superotemporal region (arrow) rather than RNFL thinning. (B) Optical coherence tomography (OCT) 3-D reconstruction imaging shows superotemporal peripapillary retinoschisis as a 3-D (arrow). (C) After 3 months of topical prostaglandin analogue medication, an OCT RNFL scan revealed a decrease in RNFL (arrow). (D) OCT 3-D reconstruction imaging shows the decreased peripapillary retinoschisis (arrow). TEMP=temporal; SUP = superior; NAS = nasal; INF = inferior.

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  Fig. 4 (A) Fundus photography. (B) Optical coherence tomography (OCT) slice at the superotemporal region from the optic disc (upper white line in A) shows inner retinal schisis cavities. (C) OCT slice at the level of the superior part of the optic disc and some part of the macula (middle white line in A) shows the peripapillary retinoschisis, not extending to the macula. (D) OCT slice at the level of the inferior part of the optic disc and the fovea (lower white line in A) shows that there is no retinoschisis in the papillomacular retinal region. (E,F,G) After 3 months of topical prostaglandin analogue medication, the OCT scan shows that the peripapillary retinoschisis is partially resolved.

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