QuizWise 10

  1. Which of the following is the least common cause for decreased central visual acuity in patients with optic nerve head pit – 
    a. Serous macular retinal detachment
    b. Cystic degeneration
    c. Macular hole
    d. Degenerative pigmentary changes
  2. Which of the following is the least common cause for decreased central visual acuity in patients with optic nerve head pit – 
    a. Serous macular retinal detachment
    b. Cystic degeneration
    c. Macular hole
    d. Degenerative pigmentary changes
  3. Which of the following features would not be seen on fundus fluorescein angiography in case of optic disc pit –
    a. Early hypo fluorescence
    b. Late hyper fluorescence
    c. Staining of the optic disc pit
    d. Active leakage of dye
  4. Acquired optic disc pit is caused due to
    a. Progressive glaucoma
    b. Pathological myopia
    c. a and b
    d. None of the above
  5. Differential diagnosis of optic disc pit associated maculopathy includes all except-
    a. Idiopathy central serous chorioretinopathy
    b. Myopic posterior pole detachment
    c. Serous pigment epithelial detachment
    d. Sub-hyloid hemorrhage

  6. Treatment options for Optic disc pit maculopathy are
    a. Laser
    b. Gas injection
    c. Internal limiting membrane peeling
    d. All of the above

QuizWise responses

  1. Answer – c : Macular Hole
    Kranenburg noted that 65% of patients had non-reversible central vision defects and macular changes leading to a decrease in central visual acuity. These macular changes were serous detachment, cystic degeneration, and degenerative pigmentary changes. In patients with ODP, serous macular detachment is seen in 25% to 75%.
    Reference Mehmet Murat Uzel, Murat Karacorlu. Optic disk pits and optic disk pit maculopathy: A review. Survey of ophthalmology, 2019 ISSN: 1879-3304, Vol: 64, Issue: 5, Page: 595-607 https://doi.org/10.1016/j.survophthal.2019.02.006
  2. Answer – b : Ring scotoma
    Optic disc pit can cause visual field defects by two mechanisms. The first is likely caused by displacement of nerve fibers by the optic pit. The most common defect seen is an arcuate scotoma, although any type of visual defect can be seen, including altitudinal defects, nasal or temporal steps, paracentral scotomas, enlarged blind spots, or generalized depression. The second mechanism is associated with a serous detachment of the retina, which usually manifests as a central scotoma or other central visual field changes.
    Reference – Shah SD, Yee KK, Fortun JA, Albini T. Optic disc pit maculopathy: a review and update on imaging and treatment. International ophthalmology clinics. 2014 Apr 1;54(2):61-78. doi: 10.1097/IIO.0000000000000025
  3. Answer – d : Active leakage of dye
    Fluorescein angiography shows early hypo-fluorescence, which is usually followed by late staining of the optic disc pit. Later hyper-fluorescence is seen in the area of the macular elevation. Pits generally do not show active leakage  and the dye does not extend to the macula. Early hypo-fluorescence is associated with serous macular detachment.
    Reference Mehmet Murat Uzel, Murat Karacorlu. Optic disk pits and optic disk pit maculopathy: A review. Survey of ophthalmology, 2019 ISSN: 1879-3304, Vol: 64, Issue: 5, Page: 595-607 https://doi.org/10.1016/j.survophthal.2019.02.006
  4. Answer c – a and b
    Acquired optic disc pit is caused by a focal optic nerve defect due to progressive glaucoma. An inferior location is more common. Acquired optic disc pit is more common in people with normotensive glaucoma, and there may be concomitant optic disc haemorrhage. Progressive disc damage and glaucomatous loss of visual field is greater in acquired optic disc pit.
    Reference – You JY, Park SC, Su D, Teng CC, Liebmann JM, Ritch R. Focal lamina cribrosa defects associated with glaucomatous rim thinning and acquired pits. JAMA ophthalmology. 2013 Mar 1;131(3):314-20.  doi:10.1001/jamaophthalmol.2013.1926
    In a case report of pathological myopia, ODP was detected with swept source OCT. Acquired disc pits of eyes with high myopia predominantly develop at the upper or lower pole of the optic disc.
    Reference – Ohno-Matsui K, Akiba M, Moriyama M, Shimada N, Ishibashi T, Tokoro T, Spaide RF. Acquired optic nerve and peripapillary pits in pathologic myopia. Ophthalmology. 2012 Aug 1;119(8):1685-92. https://doi.org/10.1016/j.ophtha.2012.01.047
  5. Answer – d : Sub-hyloid hemorrhage
    In a study of retinal findings spectral-domain OCT, fluid was found most commonly in the outer nuclear layer, followed by the inner nuclear layer, the ganglion cell layer, and the sub-internal limiting membrane. In the eyes with retinal detachment, only the outer layer of the hole was found in 27%. In 53% of the cases, there was inner and outer retinal schisis with sub-retinal fluid, whereas 38% had sub-retinal fluid and outer retinal schisis. Based on those findings, it was suggested that a possible path of fluid movement in ODP-M was that the fluid first enters the outer retinal layer and then moves bidirectionally, directly into the subretinal space, into the inner retina, or into both[1] . In another study, isolated serous macular detachment was observed in 1 patient and isolated retinoschisis in another. Moon and coworkers reported 2 ODP-M cases with serous macular detachments without inner retinal schisis.
    Reference – Mehmet Murat Uzel, Murat Karacorlu. Optic disk pits and optic disk pit maculopathy: A review. Survey of ophthalmology, 2019 ISSN: 1879-3304, Vol: 64, Issue: 5, Page: 595-607 https://doi.org/10.1016/j.survophthal.2019.02.006
  6. Answer – d : All of the above
    Laser spots were applied temporally to the optic disc and the laser scars, which are produced and act as a barrier between the optic disc pit and the sub-retinal space, preventing the entrance of fluid into the macula. The most common applied laser was the argon blue–green one, although green and krypton lasers have also been used, but the results were not as promising.
    Pneumatic tamponade may cause posterior vitreous detachment and alleviation of vitreomacular traction, which considered essential factor in the pathogenesis of the disease.
    Inverted ILM-flap use to cover the optic disc, including the ODP and excluding the foveal area.
    Reference – Chatziralli I, Theodossiadis P, Theodossiadis GP. Optic disk pit maculopathy: current management strategies. Clinical ophthalmology (Auckland, NZ). 2018;12:1417. doi: 10.2147/OPTH.S153711

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