Abstract
Purpose
To report a patient in whom a glaucomatous optic disc pit (ODP) disappeared spontaneously.
Observations
A 59-year-old Korean woman presented with primary open-angle glaucoma, an ODP, and deep superior cecocentral scotomas. She was treated with topical ocular hypotensive medications and followed. Twenty-eight months later, the superior cecocentral scotomas were not detectable with repeated visual field testing. With repeated optical coherence tomography (OCT), the ODP was narrower and shallower; partially filled with prelaminar tissue, there was an increase in the minimal rim width. At the final examination, the cecocentral scotomas reappeared, although prelaminar tissue continued to fill the ODP.
Conclusions and importance
ODP can disappear spontaneously in glaucomatous eyes under ocular hypotensive treatment. However, this is not always associated with sustained visual field improvement.
1
Introduction
Optic disc pit (ODP) is a rare finding that is sometimes detected during the evaluation of the optic disc by ophthalmoscopy or by optical coherence tomography (OCT). ODP can be congenital, resulting from an imperfect closure of the superior edge of the embryonic fissure. Or, more commonly, it can be acquired as a result of localized glaucomatous damage. In glaucomatous eyes, ODP is located mainly at the inferior or superior pole of the optic disc, and typically is accompanied by loss of neuroretinal rim along its outer border. An acquired ODP is also a risk factor for glaucoma progression, and it is spatially correlated with functional deterioration. The topography of an acquired glaucomatous ODP is thought to be permanent, and resolution after ocular hypotensive treatment has not been reported. We report here a glaucoma patient whose ODP disappeared during treatment with topical ocular hypotensive medications.
2
Case report
A 59-year-old Korean woman was referred to evaluate an abnormal optic disc. Her best corrected visual acuity was 20/20 OU, refractive error was +0.5 diopter OU (spherical equivalent), and IOP was 19 mmHg OU (Goldmann applanation tonometry). Central corneal thickness was 595 μm and 597 μm in OD and OS, respectively. Anterior segments bilateral were unremarkable. Dilated funduscopic examination revealed a near-total loss of the inferior neuroretinal rim and corresponding diffuse retinal nerve fiber layer (RNFL) loss in OS. In OD, the neuroretinal rim was normal ( Fig. 1 ). There was decreased RNFL thickness in the temporal-inferior sector and a prelaminar tissue (PLT) defect in OS with OCT that was spatially coincident with neuroretinal rim loss and RNFL thinning. Standard automated perimetry (SAP, Swedish Interactive Threshold Algorithm Standard 24-2 program, Humphrey Visual Field Analyzer 750 i ; Carl Zeiss Meditec Inc., Dublin, CA, USA) of OS showed deep superior cecocentral scotomas and shallow nasal scotomas. These changes were confirmed by a subsequent SAP ( Fig. 2 A and B). SAP of OD was normal. The patient was diagnosed with primary open-angle glaucoma with an ODP in OS. The patient was treated with topical ocular hypotensive medications including travoprost and timolol/dorzolamide fixed combination. The IOP of OS ranged from 10 to 15 mmHg on subsequent examinations.
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