Serous maculopathy secondary to disc abnormalities

From EyeWiki
Original article contributed by: Prajakta Patil, DO, DNB
All contributors: Prajakta Patil, DO, DNB
Assigned editor: Jennifer I Lim MD
Review: Assigned status Up to Date by Prajakta Patil, DO, DNB on June 1, 2017.


Serous maculopathy secondary to optic disc abnormalities

Disease

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

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

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

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

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

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.