A case of unusual coexistence of keratoconus and optic disc pit.

PURPOSE: To report a case of unusual coexistence of keratoconus and optic disc pit. METHODS: A 29-year-old male patient followed up because of the left established and right subclinical keratoconus presented with blurred vision on the left eye that occurred within days. In addition to a comprehensive ophthalmic examination, computerized corneal topography (CT), corneal pachymetry, and optical coherence tomography (OCT) examination were performed. RESULTS: The corneal CT showed a mild keratoconus pattern, with a minimum corneal pachymetry of 472 in the right eye and moderate keratoconus pattern with a minimum pachymetry of 435 micron in the left eye. The OCT scans showed the presence of the optic disc pit and related maculopathy. CONCLUSIONS: This is the second report of the coexistence of keratoconus and optic disc pit in the literature. The association of these two entities is therefore less likely to be accidental. Further histopathological studies will be necessary to explain this relationship between two entities.

Insights in ROP.

BACKGROUND AND PURPOSE: Retinopathy of prematurity (ROP) is a complex disease. We have established much of the pathophysiology of this disease including the critical roles of retinal metabolic demand and vascular endothelial growth factor (VEGF). The purpose of this paper is to provide some background material and specifically highlight issues that are new, controversial, or underappreciated. METHODS: ROP is subdivided into classification, incidence, screening, treatment, and co-morbidities. A brief background is given for each followed by highlighting specific problems attendant with current practices. RESULTS: Disease classification is accurate, reliable, and extremely useful, and can be consistently applied. However, disease behavior can occasionally confound the classification system, such as Zone III ROP with previous Zone II disease as well as the temporal wedge seen in posterior ROP. Incidences of various ROP states are well known and consistent, but the true incidence of Zone I disease and plus disease are currently debatable. Screening guidelines are currently consensus products and, as such, may contain inaccuracies and have a lack of transparency to their recommendations. Treatment of ROP now involves intravitreal injections of anti-VEGF agents, primarily bevacizumab based on economic factors. However, it may not be the best agent when systemic safety is considered. The co-morbidities of retinal schisis and its impact on disease staging, and the poor prognosis associated with vitreous hemorrhage are notable. CONCLUSIONS: ROP has yielded up many of its secrets and clinician management continues to improve. However, our knowledge continues to evolve and more refinements are necessary.

Membrane tissue on the optic disc may cause macular schisis associated with a glaucomatous optic disc without optic disc pits.

This article reports a case of possible involvement of membrane tissue on the optic disc with macular schisis formation associated with glaucomatous optic disc without optic disc pits. A 78-year-old man presented with loss of central visual acuity of the left eye. He had a medical history of primary open-angle glaucoma. Visual acuity was 0.6 in his left eye, and funduscopy revealed macular schisis and a glaucomatous optic disc without optic disc pits. Optical coherence tomography (OCT) revealed membrane tissue on the optic disc and a tunnel-like hyporeflective lesion connecting the schisis cavity and a site near the tissue, but no obvious optic disc pit. He underwent pars plana vitrectomy during which the membrane tissue on the disc and internal limiting membrane were removed. Posterior vitreous detachment was observed intraoperatively. Thereafter, the tunnel-like lesion observed on OCT was rapidly obscured and the macular schisis gradually reduced. Eighteen months after surgery, his visual acuity had improved to 0.9 with almost complete regression of the macular schisis. No optic disc pit was visualized after surgery. The changes in OCT findings described here suggest an etiology for macular schisis without optic disc pits in an eye with a glaucomatous optic disc with posterior vitreous detachment. A connection between the schisis cavity and the vitreous cavity may have appeared via the tunnel-like structure due to the membrane tissue exerting traction on the optic disc.