Acquired Optic Disc Pit Secondary to Glaucoma

A 20-year-old male patient complained of a dark area in the visual field in his right eye. He has a history of primary angle-closure glaucoma and bilateral laser iridotomy. Intraocular pressures were controlled with topical medications. There is no sign of inflammation in the anterior segment or the vitreous examination. His visual acuity was 20/25 in the right eye. There is glaucomatous cupping at 0.8-0.9 level in the patient’s right eye. At the nasal side of the macula, he has larger cysts in the Henle’s fiber layer layer and small cysts in the inner nuclear layer on OCT. Subretinal fluid is also detected adjacent to the optic disk. There is no pigment epithelial detachment. Fluorescein angiography shows peripapillary atrophy without cystoid macular edema or choroidal neovascularization. Indocyanine green angiography is unremarkable except for the round hypofluorescence area secondary to the shadowing of subretinal fluid. The detailed OCT evaluation of the optic disk shows the appearance of an optic disc pit. OCT also demonstrates that the optic disc pit is associated with cysts within the retina (red arrows). However, unlike congenital optic disc pit, several cavitations in prelaminar tissue are seen in almost all scans of the optic disc. The classic appearance of the congenital optic disc was also absent in the multicolor image. Therefore this case was diagnosed as Acquired Optic Disc Pit Secondary to Glaucoma. An acquired optic disc pit has been considered a region of localized susceptibility to the damaging effects of elevated intraocular pressure and has been associated with severe glaucoma.

You will find the images of this case below. You can also watch the video of the comparative presentation of two cases: peripapillary pachychoroid syndrome and acquired optic pit secondary to glaucoma.