Abstract
Purpose:
Acquired optic nerve pit is a rare disorder which is often caused by glaucoma. It can induce cystoid macular edema (CME) and sub-macular fluid. We present a case series of three patients with macular edema due to acquired optic nerve pit from glaucomatous damage who presented to the Henry Ford Retina Service.
Methods:
We report three patients who originally presented to the Henry Ford Retina Service with unexplained CME and/or submacular fluid and a history of glaucoma. The CME and submacular fluid are located temporal to the optic nerve, and nasal to the fovea involving the foveal center. Spectral domain ocular coherence tomography was performed with series parallel cuts to capture both the optic disc and the macula. This demonstrated that CME and subretinal fluid were connected by a tract to the optic pit. These three patients were treated with Argon or Krypton barrier laser on the temporal margin of the optic nerve. Visual acuity and OCT were used to follow up on these patients.
Results:
Our patient’s mean age is 77.3 years-old, which a range from 68 to 82, and these patients were all diagnosed with and treated for glaucoma. They all had no history of congenital optic nerve pit and their optic pits were due to glaucomatous damage. After treatment with barrier laser, patient vision improved from a mean baseline of approximately 20/40. Patients gained on average about 1 line on the Snellen visual acuity chart. OCT shows that mean central macular thickness improved from 332.3 µm before to 279.7 µm after. The tract connecting optic pit to the CME and submacular fluid is closed or nearly closed in all three patients.
Conclusions:
When unexplained cystoid macular edema with or without submacular fluid is noticed located on the nasal side of macular center, acquired optic pit should be suspected, especially in those patients with glaucoma. Spectral domain OCT should be used to detect the tract connecting the optic pit to CME and/or submacular fluid. Barrier laser is an effective method to close the tract and improve CME and submacular fluid.
Keywords: 629 optic nerve •
550 imaging/image analysis: clinical