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Original article contributed by: Prajakta Patil, DO, DNB
All contributors: Prajakta Patil, DO, DNB
Assigned editor: Vinay A. Shah M.D.
Review: Assigned status Up to Date by Prajakta Patil, DO, DNB on June 1, 2017.


Serous maculopathy secondary to optic disc abnormalities 1) Types

 Serous maculopathy associated with optic nerve head pit
 Serous maculopathy associated with tilted disc syndrome
 Serous maculopathy associated with dysplastic disc
 Serous maculopathy associated with optic nerve head coloboma

2) Serous maculopathy associated with optic nerve head pit History: Wiethe was the first one to describe this condition in 1882. Clinical Features: It is seen as greyish white excavation in optic nerve head.

                               Size of the disc is normal
                               Subretinal fluid extending from disc and involving macula

Pathophysiology: Subretinal fluid is derived from

                               -Vitreous
                               -Subarachnoid space
                               -Abnormal vessels from base of the pit

Treatment : Photocoagulation along temporal margin of the disc with intravitreal gas

                      Injection
                      Pars plana vitrectomy with fluid gas exchange with photocoagulation along 
                      temporal margin of the disc - more effective
                      

3) Serous maculopathy associated with tilted disc syndrome Clinical Features: -Presence of tilted disc( superotemporal part of optic disc lying anterior to

                                inferonasal part of disc)
                                Presence of posterior staphyloma with RPE atrophy at the edge of    
                                Staphyloma
                               

Investigations: FFA: multiple pin point leakages at the site of RPE atrophy

                          OCT: Serous macular detachment

Differential Diagnosis: Chronic CSR Management: Photocoagulation to leakage site 4) Serous maculopathy associated with dysplastic disc Clinical Features: Disc dysplasia is abnormally looking disc that does not fit into any other

                               Recognizable category

Pathophysiology : Could be similar to that of optic nerve head pit Management: Photocoagulation along temporal margin of disc 5) Serous maculopathy associated with optic nerve head coloboma Clinical Features: Enlarged disc with white glistening excavation within it

                               Subretinal fluid underneath macula extending from optic nerve

Pathophysiology: Subretinal fluid may arise from

                            - fluid perfusing into the retrobulbar space from surrounding orbital tissue
                            - peripapillary choriocapillaris
                            - CSF

Management: Photocoagulation along temporal margin of disc 6) Serous maculopathy associated with morning glory syndrome Clinical features: Funnel shaped excavation of the posterior pole involving optic disc

                              Usually unilateral if bilateral heriditary
                              Serous macular involvement in 30% cases

References: 1. Ryan SJ, Schachat AP, Wilkinson CP, Hinton DR, Sadda SR, Wiedemann P. Retina. fifth edition Vol 1. Elsevier Health Sciences; 2012. 2. Bowling B (Bradley). Kanski’s Clinical Ophthalmology : A Systematic Approach. Elsevier; 2016. 3. Cohen SY, Quentel G, Guiberteau B, Delahaye-Mazza C, Gaudric A. Macular serous retinal detachment caused by subretinal leakage in tilted disc syndrome. Ophthalmology. 1998;105(10):1831-1834. 4. Gopal L, Rao C, Sharma S. Serous macular detachment associated with dysplastic disc. Indian J Ophthalmol. 2007;55(3):224-225. 5. Lin CCL, Tso MOM, Vygantas CM. Coloboma of Optic Nerve Associated With Serous Maculopathy. Arch Ophthalmol. 1984;102(11):1651.