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Optic disc fossa oct. Optic disc fossa

The optic disc fossa is a congenital pathology of the optic nerve, characterized by a deepening in the optic disc and serous detachment in the macular area, as a result of which a decrease in visual functions occurs. The frequency of this pathology is 1 case per 10-11 thousand population. Macular disorders usually occur between the ages of 20 and 40, but this pathology was first described by Wyeth in 1882 in a 62-year-old woman.

There are several theories of fluid migration into the macular zone: from the vitreous body, cerebrospinal fluid, choroidal vessels or optic disc vessels. Fluid from the optic disc fossa spreads into the macular zone, usually into the inner or outer nuclear layers, forming macular schisis. Many authors pay special attention to the influence of the vitreous body in the pathogenesis of macular edema.

Conservative treatment of the optic disc pit is ineffective; the use of steroid and non-steroidal anti-inflammatory drugs does not reduce macular edema, since the hole in the disc disc does not close.

Various methods of surgical treatment of the optic disc fossa have been proposed: restrictive laser coagulation of the retina along the border of the subretinal cavity with YAG laser retinopuncture along the lower border of the edema, a combination of laser treatment with intravitreal gas injection, vitrectomy with restrictive laser coagulation of the retina along the border of the subretinal cavity with mechanical retinopuncture along the lower border edema, vitrectomy with removal of the ILM and gas-air tamponade. Recently, new methods of surgical treatment have been proposed, such as the use of an inverted ILM flap. The modern technique of cutting out a flap of the internal limiting membrane allows not only to close large holes in the macular area, but also to cover the optic disc fossa.

From our point of view, methods of using platelet mass are very promising in this direction. Currently, this mass is very effectively used to treat patients with idiopathic macular holes.

Purpose our study was to evaluate the effectiveness in various ways surgical treatment of the optic disc fossa.

Material and methods

We analyzed 3 cases of patients treated in the Cheboksary branch of the Federal State Institution “MNTK “Eye Microsurgery” named after Academician S.N. Fedorov" in 2016-2017.

Case No. 1

Patient S., 58 years old. Complaints of decreased visual acuity in the left eye over the past 3 months. Upon admission Vis OS=0.2 cyl -0.5D ax 101°=0.3; on OST of the macular zone OS, cystic edema of the retina, height at the level of the fovea = 538 µm, neuroepithelial detachment; on OST ONH OS there is a pronounced decrease in the layer of nerve fibers.

Surgical treatment was performed: OS - intravitreal injection of C3F8 gas with a forced head position “face down” in the postoperative period.

Case No. 2

Patient K., 68 years old. History of concomitant ocular pathology - o/v glaucoma Ia; in 2011, surgical treatment of OD was performed - FEC + IOL + trabeculotomy.

When appearing for control in 2015, Vis OD=0.7n/k; IOP=20 mm Hg. Perimetry reveals an arcuate scotoma; on OST Mac. zones without features, OST ONH - a pronounced decrease in the layer of nerve fibers. There are no antihypertensive drops.

The patient came for follow-up 1 year later (in 2016) with complaints of decreased vision in the right eye Vis OD=0.3 n/k; IOP=21 mm Hg; on OST Mac. zones of extensive high detachment of the neuroepithelium in the fovea and parafoveolar, spreading to the optic disc, splitting of the retinal layers.

Surgical treatment was performed: OD - vitrectomy with removal of the PGM, ILM, ELKS and tamponade of the vitreal cavity with air.

The patient came for follow-up after 1 month. Vis OD=0.3 n/k; IOP=20 mmHg; OST mac. zones - weak positive dynamics with persistence of edema in the macular zone.

Then the patient came for follow-up after 3 months. after operation. Vis=0.2-0.3n/k; IOP=20 mmHg; on OST Mac. zones - edema, detachment of the neuroepithelium in the fovea and parafoveolar. The next visit was 6 months later. after operation. Vis=0.2 n/k; IOP=21 mm. Hg; on OST Mac. zones - neuroepithelial detachment, maximum height of edema - 762 µm, at the level of the fovea - 618 µm (Fig. 1).

Considering the recurrence of macular edema, as well as negative dynamics in visual acuity, repeated surgical treatment was performed: OD - revision of the vitreal cavity with temporary PFOS tamponade, retinopuncture with a 30 G needle with drainage of subretinal fluid, subretinal injection of platelet mass, tamponade of the vitreal cavity with a gas-air mixture (C3F8) .

Case No. 3

Patient R., 35 years old. Complaints of decreased vision in the left eye over the past year, the appearance of a “dark spot” in front of the eye. Upon admission Vis OS=0.3 sph+0.75D=0.4; on OST of the macular zone - retinal edema, height at the level of the fovea = 644 µm, neuroepithelial detachment; on the OST of the optic disc - a pronounced decrease in the layer of nerve fibers.

Surgical treatment was performed: OS - vitrectomy with removal of the optic disc and formation of an inverted flap from the intraocular disc towards the optic disc fossa. To press the flap into the disc fossa, temporary PFOS tamponade was used, followed by the application of platelet mass to fix the flap.

After an exposure of 3 minutes, PFOS was removed and air tamponade of the vitreal cavity was performed. In the postoperative period, the position was “face down” for 7 days.

results

Case No. 1

The patient came for follow-up after 3 months. after operation. She did not notice any changes from the treatment.

Vis OS=0.3 n/k; on OST of the macular zone OS - positive dynamics of reduction of cystic edema of the retina, height at the level of the fovea = 482 µm; on OST ONH OS - a pronounced decrease in the layer of nerve fibers.

As a result of the treatment, macular edema was reduced by 56 µm (Fig. 2).

Considering the positive dynamics, the patient was recommended for dynamic observation with monitoring of OCT poppy. zones in another 3 months. If the situation worsens, the issue of vitrectomy will be decided.

Case No. 2

The patient came for follow-up after 6 months. after reoperation. I felt positive dynamics from the surgical treatment and noted an improvement in my vision.

Vis OD=0.3 cyl-0.75D ax130°=0.5; IOP=19 mm Hg. On OST of the macular zone OS - positive dynamics, absence of edema in the macular zone, height at the level of the fovea = 210 µm. The treatment allowed to eliminate the swelling of the poppy. zones at 408 µm (Fig. 3).

Case No. 3

The patient came for follow-up after 5 months. after operation. She noted a clearing of the “spot” in front of her left eye. Vis OS=0.4 n/k; on OST of the macular zone OS - positive dynamics, almost complete absence of retinal edema, height at the level of the fovea = 278 µm; on the OCT of the optic disc - a reverse flap of the ILM covering the optic disc (Fig. 4).

As a result of the treatment, it was possible to reduce macular edema in this case by 366 µm (Fig. 5).

Conclusion

Thus, vitrectomy with removal of the PGM and ILM is effective method treatment of the optic disc fossa, allowing to reduce macular edema and improve visual acuity.

Covering the fossa with an inverted ILM flap has also been shown to be an effective and safe treatment option. And even safer, given the absence of the need for retinotomy and additional manipulations with subretinal contents. The use of platelet mass for additional fixation of the flap may reduce the likelihood of recurrence of macular edema. However, more observations are required.

If macular edema recurs, subretinal administration of platelet mass is possible.

Keywords

OPTIC DISC FALL / CENTRAL RETINAL DETACHMENT / PNEUMORETINOPEXY / LASERCOAGULATION/ OPTIC DISC FOVEA / CENTRAL RETINAL DETACHMENT / PNEUMORETINOPEXIA / LASER COAGULATION

annotation scientific article on clinical medicine, author of the scientific work - Konyaev Dmitry Aleksandrovich

Pits (depressions) in the optic nerve head are a common congenital anomaly, the pathogenesis of which is not entirely clear. V.N. Arkhangelsky (1960) considered it as a variant of disc hypoplasia with a partial delay in the ingrowth of nerve fibers; other authors associate the formation of pits with the introduction of folds of the rudimentary retina into the intervaginal spaces of the optic nerve, although some authors regard optic disc fossa(ONH) as one of the forms of optic nerve coloboma. Occurrence optic disc pits in the population 1:10 000 1:11 000. In approximately 45-75% of eyes with congenital optic disc fossa serous detachment develops in the macular area. A method of surgical treatment is presented based on the results of patients operated on in the Tambov branch of the Eye Microsurgery MNTK named after. acad. S.N. Fedorov with optic disc fossa and complicated neuroepithelial detachment. The operations were completed without complications. The analysis showed that a good functional and morphological result was obtained. Two weeks later, after complete resorption of the gas-air mixture, visual acuity improved markedly, and resorption of subretinal fluid was noted until complete adhesion of the neuroepithelium a month after surgery.

Our experience of the optical disc fovea treatment

The fovea (deepening) in the optic disk is a frequent congenital abnormality, the pathogenesis of which is not entirely clear. V.N. Arkhangelsky (1960) considers it as a variant of the optic disc hypoplasia with the partial delay of the nerve fibers ingrowth. The other authors link the fovea formation with the introduction of the folds of the rudimentary retina into the intervaginal spaces of the optic nerve, although some authors consider the optic disc fovea (ODF) to be a form of the optic nervecoloboma. The optic disc fovea incidence in population is 1:10 000 1:11 000. Approximately, in 45-75% of eyes with congenital optic disc fovea the serous detachment develops in macular area. The paper presents a method of surgical treatment based on the results of the patients with optic disc fovea (ODF) and complicated neuroepithelial detachment operated on in Academician S.N. Fyodorov FSBI IRTC “Eye Microsurgery” Tambov branch. There were no complications. The analysis showed that a good functional and morphological result was achieved. Two weeks later after the gas/air mixture resolution visual acuity improved noticeably. Also the resorption of subretinal fluid until the neuroepithelium fully being adjoined was noted one month after the surgery.

Text of scientific work on the topic “Our experience in surgical treatment of the optic disc fossa”

UDC 617.753

OUR EXPERIENCE IN SURGICAL TREATMENT OF THE OPTIC DISC PITCH

Pits (depressions) in the optic nerve head are a common congenital anomaly, the pathogenesis of which is not entirely clear. V.N. Arkhangelsky (1960) considered it as a variant of disc hypoplasia with a partial delay in the ingrowth of nerve fibers; other authors associate the formation of pits with the introduction of folds of the rudimentary retina into the intervaginal spaces of the optic nerve, although some authors regard the pit of the optic disc (OND) as one of the forms of optic coloboma nerve. The occurrence of the optic disc pit in the population is 1:10,000 - 1:11,000. Approximately 45-75% of eyes with a congenital optic disc pit develop serous detachment in the macular area. A method of surgical treatment is presented based on the results of patients operated on in the Tambov branch of the Eye Microsurgery MNTK named after. acad. S.N. Fedorov with optic disc fossa and complicated neuroepithelial detachment. The operations were completed without complications. The analysis showed that a good functional and morphological result was obtained. Two weeks later, after complete resorption of the gas-air mixture, visual acuity improved markedly, and resorption of subretinal fluid was noted until complete adhesion of the neuroepithelium a month after surgery.

Key words: optic disc fossa; central retinal detachment; pneumoretinopexy; laser coagulation.

The optic disc fossa (ONH) is a congenital anomaly, which is a limited depression in the optic disc. The optic disc fossa was first described by Wyeth in 1882 in a 62-year-old woman. The incidence of this pathology was determined as 1:10,000 - 1:11,000. The pathogenesis of the disease is unclear; it is believed that its cause is a disturbance in the structural development of the optic disc, although some authors regard the optic disc fossa as one of the forms of optic nerve coloboma. But there are facts that do not agree with this hypothesis. First, the disc pits are often located in areas related to the fetal cleft. Secondly, disc pits are usually unilateral, sporadic, and not associated with other developmental anomalies. Third, disc pits are not associated with iris or retinal colobomas, although optic coloboma may sometimes present with a crater-shaped deformation resembling an optic disc pit, and it may be difficult to distinguish an inferior pit from a small coloboma. The above facts seem sufficient to prove the obvious difference in the pathogenesis of colobomas and optic pits. There is also a hypothesis for the development of optic disc pits, which is due to a partial delay in the ingrowth of nerve fibers into the optic nerve canal. The presence of one or more cilioretinal vessels emerging from most of the optic nerve fossae suggests that this fact is also somehow related to the pathogenesis of the anomaly.

Approximately 45-75% of eyes with congenital optic disc pit develop serous detachment in the macular region.

Clinically, during ophthalmoscopy, the optic disc fossa looks like a round, oval, sometimes polygonal depression with a white, gray or yellow color. It is mainly located in the temporal part of the disc, sometimes in the center and extremely rarely in its nasal part, and its diameter varies from 1/3 to 1/8 of the diameter of the optic disc. In the visual field, defects are detected in the form of expansion of the boundaries of the blind spot, similar to those in glaucoma.

Visual acuity in such patients remains normal until a detachment appears in the macular region of the retina, which usually occurs by the age of 16. Then visual acuity may decrease to 0.1 and to a lower level. It becomes irreversible if the detachment persists for more than 6 months. With the long-term existence of serous retinal detachment, the pigment epithelium in the detachment zone suffers; cases of the formation of a through macular hole are described. A possible complication is choroidal neovascularization at the optic disc margin.

Many authors considered the source of subretinal fluid in optic disc fossae to be the vitreous body, others - cerebrospinal fluid, and still others - choroidal vessels or vessels located within the fossa itself. Spontaneous reattachment of serous detachment as a result of resorption of subretinal fluid occurs in approximately 25% of cases and can occur many months or even years after its appearance. Subsequent studies showed that not only fluid flow, but also traction from the vitreous body plays a significant role in the occurrence of central retinal detachment. Cases are described as proof of their hypothesis

successful treatment of retinal detachment in the optic disc fossa using vitrectomy.

With fluorescein and indocyanine angiography, the zone of serous detachment is hypofluorescent in the early phase due to screening of choroidal fluorescence. On delayed images, its weak hyperfluorescence is determined. In the presence of local alterations of the pigment epithelium, hyperfluorescence similar to fenestrated defects is observed. Studies using optical coherence tomography (OCT) and fluorescein angiography (FA) have made it possible to study the relationship of the optic disc fovea with central retinal detachment. According to these data, retinoschisis of the inner layers of the retina is formed, against the background of which the central detachment of the outer layer of the retina from the pigment epithelium develops for the second time. Thus, there is a two-layer structure of maculopathy in the optic disc fossa. The optic disc fossa plays a connecting role in the flow of fluid between the cavity of retinoschisis or detachment and the subarachnoid space. Using OCT, it was found that fluid from the optic disc fossa can leak into the inner and outer nuclear layers or into the subretinal space, although most often it is the outer nuclear layer.

Conservative treatment of the optic disc pit using corticosteroids does not produce results, since the effect of steroids is temporary, and the rupture is not blocked. According to the authors, the combination of laser treatment with intravitreal injection of SF6 or C3F8 gas, or with silicone tamponade has a more pronounced therapeutic effect (up to 70%) compared to laser treatment as monotherapy (only in 30% of patients).

Extrascleral filling of the posterior pole of the eye is not widespread. The surgical technique involves suturing a sponge to the posterior pole, the correct position of which is determined using ultrasound B-scanning during surgery. Then, within 1 week after surgery, indocyanine angiography was performed to determine blood circulation in the choroid, as well as magnetic resonance imaging of the orbit to clarify the position of the sponge relative to the optic nerve. No other additional treatment methods (laser coagulation, cryotherapy, etc.) were used. Retinal reattachment was observed in all eyes.

Barrier argon laser coagulation of the retina along the border of the subretinal cavity and simultaneously YAG laser retinopuncture along the lower border of this cavity leads to a decrease in the height of neuroepithelial detachment and an improvement in visual acuity. However, there is incomplete adhesion of the detachment, D.C. fluid under the neuroepithelium and paramacular hole.

Vitrectomy with removal of only the posterior hyaloid membrane, injection of gas without laser coagulation and horizontal position face down for 7 days led to positive result. OCT performed before and after surgery showed the presence of not only retinal detachment, but also “multilayer” retinoschisis.

However, later, some patients experienced recurrence of retinal detachment after 8 years, which was associated with tangential traction from the internal limiting membrane or residual vitreal cortex. This required additional surgical intervention with peeling of the internal limiting membrane and subsequent introduction of a gas-air mixture into the vitreous cavity. Thus, the optimal method of surgical treatment for this very rare pathology has not yet been established.

The purpose of the study is to analyze the surgical treatment of the optic disc fossa.

MATERIALS AND METHODS

2 patients (2 eyes) were operated on at the Tambov branch of the Eye Microsurgery MNTK named after. acad. S.N. Fedorov with optic disc fossa complicated by neuroepithelial detachment. Both patients are male, the patients are 29 and 27 years old. Patients complained of decreased vision and a “dark spot” in front of the eye for one year. The patients underwent standard studies: visometry, autokeratorefractometry, tonometry, perimetry, biometry, B-scan, electrophysiological studies, biomicroscopy, ophthalmoscopy. Optical coherence tomography was performed as an additional study.

The initial indicators are presented in table. 1 and in Fig. 1-2.

OPERATIONAL TECHNIQUE

Central vitrectomy 25 Ga, removal of the posterior hyaloid membrane, laser coagulation, and tamponade with a gas-air mixture were performed. Patient B. additionally underwent removal of the internal limiting membrane. Laser coagulation was carried out using the “Emerald” device from Alcom Medica, St. Petersburg. Laser coagulates are applied in 3 rows on the nasal side of the optic disc, radiation power 0.2 W, exposure 0.15 s. After 2 weeks, after complete resorption of the gas-air mixture, the patient underwent “lattice” laser coagulation in the macular area using a Quantel medical Supra 577 Y device. Laser parameters: power 0.1 W, exposure 0.1 s, beam diameter 125 μm.

The follow-up period for patient A was 4 years, for patient B - 2 months.

Table 1

Patient baseline

Indicators Patient A. Patient B.

Age, years 29 27

B-scan data In the central zone, retinoschisis In the central zone, retinal detachment

Detachment height, µm 667 604

table 2

Visual acuity and height of neuroepithelial detachment after surgery

Term Patient A. Patient B.

observations Visus Detachment height, µm Visus Detachment height, µm

after 2 weeks 0.25 78 0.4 102

after 1 month 0.25 almost complete fit 0.5 complete fit

after 2 months 0.35 complete fit 0.6 complete fit

after 6 months 0.5 complete fit

after 3 years 0.7 complete fit

RESULTS AND DISCUSSION

The operations were completed without complications. Two weeks later, after complete resorption of the gas-air mixture, patients noted an improvement in visual acuity. According to OCT data, resorption of subretinal fluid is noted until complete adhesion of the neuroepithelium one month after surgery. The results are presented in table. 2 and in Fig. 3-4.

CONCLUSION

Thus, the results of the study show that microinvasive vitrectomy with removal of the posterior hyaloid and internal limiting membrane, endolaser coagulation, gas-air tamponade and “lattice” laser coagulation after two weeks gives a good morphological (according to OCT data) and functional result (according to visual acuity data ) in early and late stages.

BIBLIOGRAPHY

1. Avetisov S.E., Kashchenko T.P., Shamshinova A.M. Visual functions and their correction in children. M.: Medicine, 2005. 872 p.

2. Throne E.Zh. Visual pathway disease. L., 1968. S. 313-322. Chapter 13.4.

3. Bayborodov Ya.V., Rudnik A.Yu. Minimally invasive removal of the ILM in the treatment of complicated optic disc pits // Modern technologies treatment of vitreoretinal pathology: scientific and practical materials. conf. M., 2012. pp. 27-30.

4. Apple D.J., Rabb M.F., Walsh P.M. Congenital anomalies of the optic disc. //Surv. Ophthamol. 1982. V. 27. No. 1. P. 3-41.

5. Ganichenko I.N. Treatment of the optic nerve fovea and its complications using photo- and laser coagulation // Ophthalmological Journal. 1986. No. 4. P. 199-203.

6. Malakyan N.Yu., Sdobnikova S.V. Treatment of retinal detachments in the optic disc pits // Vestn. ophthalmology. 2012. No. 3. P. 62-64.

7. Shamshinova A.M. Hereditary and congenital diseases of the retina and optic nerve. M., 2001. S. 487-489.

8. Akiba J., Kakehashi A. et al. Vitreous finding in cases of optic nerve pits and serous macular detachment // Am. J. Ophthalmol. 1993. V. 116. No. 1. P. 38-41.

9. Gass J.D. Serous detachment of the macula. Secondary to congenitial pit of the optic nervehead // Am. J. Ophthalmol. 1969. V. 67. No. 6. P. 821-841.

10. Montegro M, Bonnet M. Optic nerve pits: clinical and therapeutic review of 21 cases // J. Fr. Ophthalmol. 1989. V. 12. No. 6-7. P. 411-419.

11. Gordon R., Chatfield R.K. Pits in the optic disc associated with macular degeneration // Br. J. Ophthalmol. 1969. V. 53. No. 7. P. 481-489.

12. Hirakata A., Odaka A.A., Hida T. Long-term results of vitrectomy sithout laser treatment for macular detachment associated with an optic disc pit. // Ophthalmology. 2005. V. 112. No. 8. P. 1430-1435.

13. Lincoff H., Schiff W., Krivy D., Ritch R. Optical coherence tomography of optic disc pit maculopathy // Am. J. Ophthalmol. 1996. V. 122. No. 2. P. 264-266.

14. Theodossiadis G.P. Treatment of maculopathy associated with optic disc optic by sponge explant // Am. J. Ophthalmol. 1996. V. 121. No. 6.

15. Yanyali A., Bonnet M. Treatment of macular detachment complicating optic disc coloboma pits. Long-term results of the photocoagulation-gas combination // J. Fr. Ophthalmol. 1993. V. 16. No. 10. P. 523-531.

Konyaev Dmitry Aleksandrovich, Tambov branch of the MNTK "Eye Microsurgery" named after. acad. S.N. Fedorova, Tambov, Russian Federation, ophthalmologist of the 3rd ophthalmology department, e-mail: [email protected]

DOI: 10.20310/1810-0198-2016-21-1-214-218

OUR EXPERIENCE OF THE OPTIC DISC FOVEA TREATMENT

The fovea (deepening) in the optic disk is a frequent congenital abnormality, the pathogenesis of which is not entirely clear. V.N. Arkhangelsky (1960) considers it as a variant of the optic disc hypoplasia with the partial delay of the nerve fibers ingrowth. The other authors link the fovea formation with the introduction of the folds of the rudimentary retina into the intervaginal spaces of the optic nerve, although some authors consider the optic disc fovea (ODF) to be a form of the optic nervecoloboma. The optic disc fovea incidence in population is 1:10 000 - 1:11 000. Approximately, in 45-75% of eyes with congenital optic disc fovea the serous detachment develops in macular area. The paper presents a method of surgical treatment based on the results of the patients with optic disc fovea (ODF) and complicated neuroepithelial detachment operated on in Academician S.N. Fyodorov FSBI IRTC "Eye Microsurgery" Tambov branch. There were no complications. The analysis showed that a good functional and morphological result was achieved. Two weeks later after the gas/air mixture resolution visual acuity improved noticeably. Also the resorption of subretinal fluid until the neuroepithelium fully being adjoined was noted one month after the surgery.

Key words: optical disc fovea; central retinal detachment; pneumoretinopexia; laser coagulation.

1. Avetisov S.E., Kaschenko T.P., Shamshinova A.M. Zritelynye funktsii i ikh korrektsiya u detey. Moscow, Meditsina Publ., 2005. 872 p.

2. Tron E.Zh. Zabolevanie zritelynogoputi. Leningrad, 1968. 394 p.

3. Bayborodov Ya.V., Rudnik A.Y. Minimalynoe invazivnoe udalenie VPM v lechenii oslozhnennykh yamok diska zritelynogo nerva.

Sovremennye tekhnologii lecheniya vitreoretinalynoy patologii: materialy scientific-prakticheskoy konferentsii. Moscow, 2012, pp. 2730.

4. Apple D.J., Rabb M.F., Walsh P.M. Congenital anomalies of the optic disc. Survey of Ophthalmology, 1982, vol. 27, no. 1, pp. 3-41.

5. Ganichenko I.N. Lechenie yamki zritelynogo nerva i ee oslozhneniy metodom foto- i lazerkoagulyatsii. Oftalymologicheskiy zhurnal, 1986, no. 4, pp. 199-203.

6. Malakyan N.Y., Sdobnikova S.V. Lechenie otsloek setchatki pri yamkakh disca zritelynogo nerva. Vestnik oftalymologii, 2012, no. 3, pp. 62-64.

7. Shamshinova A.M. Nasledstvennye i vrozhdennye zabolevaniya setchatki i zritelynogo nerva. Moscow, 2001. 528 p.

8. Akiba J., Kakehashi A. et al. Vitreous finding in cases of optic nerve pits and serous macular detachment. American Journal of Ophthalmology, 1993, vol. 116, no. 1, pp. 38-41.

9. Gass J.D. Serous detachment of the macula. Secondary to congenital pit of the optic nervehead. American Journal of Ophthalmology, 1969, vol. 67, no. 6, pp. 821-841.

10. Montegro M., Bonnet M. Optic nerve pits: clinical and therapeutic review of 21 cases. Journal Francais D "Ophtalmologie, 1989, vol. 12, no. 6-7, pp. 411-419.

11. Gordon R., Chatfield R.K. Pits in the optic disc associated with macular degeneration. British Journal of Ophthalmology, 1969, vol. 53, no. 7, pp. 481-489.

12. Hirakata A., Odaka A.A., Hida T. Long-term results of vitrectomy sithout laser treatment for macular detachment associated with an optic disc pit. Ophthalmology, 2005, vol. 112, no. 8, pp. 1430-1435.

13. Lincoff H., Schiff W., Krivy D., Ritch R. Optic coherence tomography of optic disc pit maculopathy. American Journal of Ophthalmology, 1996, vol. 122, no. 2, pp. 264-266.

14. Theodossiadis G.P. Treatment of maculopathy associated with optic disc optic by sponge explant. American Journal of Ophthalmology, 1996, vol. 121, no. 6, pp. 630-637.

15. Yanyali A., Bonnet M. Treatment of macular detachment complicating optic disc coloboma pits. Long-term results of the photocoagulation-gas combination. Journal Francais D "Ophtalmologie, 1993, vol. 16, no. 10, pp. 523-531.

Konyaev Dmitriy Aleksandrovich, Academician S.N. Fyodorov FSBI IRTC "Eye Microsurgery", Tambov branch, Tambov, Russian Federation, Ophthalmologist of the 3rd Ophthalmologic Department, e-mail: [email protected]

4921 0

The optic pit is a fairly rare congenital malformation, occurring in 1 in 11 thousand ophthalmic patients. In approximately 85% of cases, the disease is unilateral; men and women are affected equally often. It manifests itself between the ages of 20 and 40 as decreased vision caused by macular disorders.

Although the pathogenesis of the disease is not fully known, as a rule, it is associated with incomplete closure of the embryonic palpebral fissure. No connection between the optic fovea and systemic diseases has been identified. Histologically, expansion and displacement of the scleral canal, penetration of the retina into the optic nerve trunk, rudimentary retinal tissue in the disc area, and retinal nerve fibers on the walls of the coloboma are detected. Inherited in an autosomal recessive manner.

Ophthalmoscopically, the optic nerve fovea is a round or oval depression in the optic disc, grayish in color, with clear boundaries, measuring from 1/8 to 1/2 the diameter of the disc (Fig. 1). Usually the fossa is localized in the temporal half of the optic disc. Very rarely there are two pits; the second in these cases is localized in the nasal half of the disc. The pits have varying depths, sometimes vessels are visible at the bottom. In most cases, the affected disc is enlarged in size.

The most common complication of the optic fovea is retinal separation (schisis) in the macula. One of the probable causes of the formation of retinoschisis in the macular area is the flow of cerebrospinal fluid from the subarachnoid into the subretinal space. It is possible that intravitreal fluid penetrates through the optic nerve fossa, which, if persisted for a long time, leads to the development of cystic macular edema and even a through macular hole. Treatment of the optic nerve fossa is carried out when visual acuity is reduced due to retinoschisis and currently consists of transciliary vitrectomy, gas-air tamponade, possibly in combination with laser photocoagulation along the edge of the fossa.

Optical coherence tomography clearly illustrates optic disc defects and retinal dissection, changes occurring in the fovea (Fig. 2, 3).

Rice. 1. Biomicroscopy of the fundus of a patient with an optic fossa and retinoschisis, which involves the macula. Visual acuity 0.1.

Rice. 2. Tomogram through the macula and optic nerve of a patient with an optic fossa. On a horizontal scan, the retina is separated into several layers. The connection between the intraretinal and vitreal spaces was not identified, while at the same time a channel into the subarachnoid space was visible.

PITs OF THE OPTIC NERVE

Optic disc pits

Optic disc pits are a rare congenital disease, manifesting between the ages of 20 and 40 as decreased vision caused by serous macular detachment.

Diagnostics

The main diagnostic methods are ophthalmoscopy and FAGD.

Clinic

Oval grayish-white depressions measuring from 1/8 to 1/2 DD are detected in the temporal sector of the optic nerve head. In the macular area there is edema (detachment of the neuroepithelium), sometimes cystic degeneration of the retina. FAGD detects late fluorescence of the optic disc pits. Detachment of the neuroepithelium in the macular area in this pathology is not contrasted in the early and late phases of FAHD (Fig.,).

Treatment

Laser coagulation along the edge of the optic nerve head and barrier laser coagulation delimiting the zone of neuroepithelial detachment.

Literature

Katsnelson L. A., Forofonova T. I., Bunin A. Ya. Vascular diseases of the eyes. - M.: Medicine, 1990. - P. 217-226.
Gass J.D. Stereoscopic atlas of macular diseases. St. Louis. etc.: CV Mosby Co., 1977. - R. 368-410.


	FAGD. Arteriovenous phase. Hyperfluorescence of the optic disc fossa without secondary focal changes in the center



	A unique case is a foreign body on the optic disc, simulating the optic disc fossa.
	Non-fluorescent optic disc pit. Hyperfluorescence in the central zone of the fundus in the form of small foci as a result of disorganization of the pigment epithelium. FAGD. Arteriovenous phase.
	FAGD of the same patient. Late phase. Bright hyperfluorescence of the optic disc fossa, with secondary changes in the center.

- a congenital anomaly, which is a limited depression in the optic nerve discs. The disease occurs in the population with frequency 1: 10 LLC-11 LLC; first described by T. Wiethe (1882).

Pathogenesis. The pathogenesis of the optic disc pit is unclear. Some authors suggest that the optic disc fossa; is a mild form of optic nerve coloboma, i.e. also caused by incomplete closure of the palpebral fissure. Its supporters cite rather rare cases of a combination of coloboma and optic disc fossa as arguments confirming this point of view.

There are facts that do not agree with this hypothesis: firstly, the disc fossae are often located in places related to the embryonic cleft; secondly, disc pits are usually unilateral, sporadic and not combined with other developmental anomalies; thirdly, disc pits are not combined with colobomas of the iris or retina. Although optic coloboma may sometimes present as a crater-shaped deformation resembling a pit of the optic disc, and it may be difficult to distinguish a lower-segment pit from a small coloboma, the facts presented above seem sufficient to demonstrate the obvious difference in the pathogenesis of coloboma and optic pits. nerve. The presence of one or more cilioretinal vessels emerging from most of the optic nerve fossae suggests that this fact is also somehow related to the pathogenesis of the anomaly.

Histological studies. In the area of the fossa there is a defect in the cribriform plate. The retinal fibers descend into the fossa, then return and exit in front of the incoming optic nerve. Some fossae communicate with the subarachnoid space.

Clinical manifestations. With ophthalmoscopy, the optic disc fossa looks like a round or oval depression that is white, gray or yellow (Fig. 13.27).

The diameter of the optic disc pits varies from 1/3 before 1/8 RD. Usually the fossa is localized in the temporal half of the disc, but it can also be located in other sectors. The disease is often unilateral. The bilateral optic disc fossae meet in 15 % cases. When the lesion is unilateral, the abnormal disc appears slightly enlarged compared to the normal one.

If the disc fossa is of significant size, its sagittal section can be obtained using B-echography; for small sizes - optical coherence tomography.

Approximately in 45-75 % eyes with a congenital optic disc pit develop serous macular detachment. Lineoff et al. (1988) studied the course of development of macular complications:

The route of intraretinal fluid has not yet been precisely established. Possible moaners are indicated in the literature:

vitreal cavity through the fossa;
blood vessels at the base of the fossa;
subarachnodal space;
al vessels.

Macular retinoschisis and retinal detachment caused by the disc fossa develop with age 10- 40 years. The risk of developing macular complications is higher in cases where the optic disc fossa is large and localized in the temporal half of the disc. In cases where macular detachment exists for a long time (for 6 years or more), pigment is deposited along the edge of the disc and/or along the border of the detachment. Pigment deposits are caused by disturbances in the retinal pigment epithelium layer, in which extensive defects form over time. G. Theodossiadis et al. (1992) found that when macular detachment exists for 10 years or more, the size of the disc fossa increases, and its color becomes gray, which is probably due to the loss or restructuring of glial tissue within the fossa.

Fluorescein angiography. In the arterial and arteriovenous phases, a gradually increasing leakage of fluorescein is determined in the zone of neuroepithelial detachment towards the macula. In the early phases of FA or indocyanine angiography, the disc fossa usually does not allow contrast material to pass through. In the late phase of FA or indocyanine angiography, hyperfluorescence of the disc fossa and the area of macular detachment occurs.

Psychophysical research. Visual acuity in patients with optic disc fossa remains normal until the onset of macular complications. TO 16 -adult age due to the development of macular detachment of the neuroepithelium, visual acuity 0,1 and below note at 80 % patients. Visual field defects are varied and often do not correlate with the location of the fovea. With persistent macular changes, defects in the visual field progress. Scotomas detected in the visual field correspond to defects in the retinal pigment epithelium detected by ophthalmoscopy or FA.

Electrophysiological studies. The ERG remains normal in most patients even in cases of macular complications. VVP are not changed until the development of macular detachment. With the appearance of macular complications, a decrease in the amplitude of the P100 component is noted in all cases. less often - prolongation of its latency.

Treatment. Conservative treatment, including dehydration therapy and topical corticosteroids, is ineffective. Previously, laser coagulation of the retina was used to block the flow of fluid from the disc fossa to the macula, but the effectiveness of this technique was quite low and difficult to predict due to the impossibility of adequately covering the retinoschisis cavity using laser coagulation alone. Currently, a combined technique is used, including vitrectomy followed by intravitreal tamponade with expanding perfluorocarbon gas and barrier laser coagulation. Combined treatment makes it possible to achieve improved visual acuity in all patients and anatomical success in 87 % .

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