Author: Odysseas Georgiadis (United Kingdom)
Co-authors: Odysseas Georgiadis, James McHugh, Anna Grabowska
Purpose
To present an unusual case of serous intraretinal fluid accumulation, resembling optic disc pit maculopathy, in the absence of disc pit, associated with a retrobulbar, cystic, optic nerve sheath lesion.
Setting/Venue
Ophthalmology Department, King’s College Hospital, NHS Foundation Trust, London, UK.
Methods
A 58 years old black Caribbean male, otherwise fit and well, presented with an incidental finding of retinal swelling around the optic disc and extending to the macula of his Left eye. Full ophthalmological examination was performed, including optical coherence tomography (OCT), Humphrey visual fields (HVF) and magnetic resonance imaging (MRI) of the brain and orbits. The patient has been followed up for 18 months.
Results
On presentation, his Left eye visual acuity and intraocular pressure were normal, his anterior segment unremarkable, while fundoscopy revealed the presence of serous fluid superiorly to the optic disc and in superior macula. OCT confirmed the presence of intraretinal fluid around the superior half of the optic disc and macula, resembling the configuration of optic disc pit maculopathy. No disc pit was detected. The HVF test revealed a superior arcuate scotoma, respecting the horizontal midline. The Right eye was normal. The MRI scan revealed an unusual configuration of the left intraorbital optic nerve/sheath complex, with the optic nerve having a crescent shape in cross-section, and appearing indented inferiorly by a fluid filled structure, resembling an arachnoid cyst. No abnormal enhancement or solid intraorbital lesion was detected. The MRI was repeated 10 months later, showing no changes in comparison. No intervention was decided and the patient has been monitored for 18 months. His visual acuity remains normal, although the intraretinal fluid has progressed causing a macular schisis, involving the fovea.
Conlusions
Serous macular schisis resembling optic disc pit maculopathy can occur in the absence of an anatomical pit. Association with a retrobulbar optic nerve lesion, although rare, it is possible; therefore, further investigation and thorough imaging is essential. There is no definite explanation about the origin of the intraretinal fluid. The presence of an arachnoid cyst in our case supports one of the suggested theories that attributes cerebrospinal fluid characteristics to the intraretinal fluid, caused by an anatomic connection between the retina and the subarachnoid space. As in optic disc pit maculopathy, good visual function allows a conservative management by observation, and monitoring with OCT scans.
Financial Disclosure
Nothing to disclose
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