Mangum Andrew J
Optom Vis Sci. 2022 Mar 1;99(3):308-314. doi: 10.1097/OPX.0000000000001864.
Congenital optic disc pits are known to cause complications, commonly maculopathy due to retinoschisis and/or neurosensory retinal detachment. Retinal nerve fiber layer defects with associated visual field defects without maculopathy are another complication and can result in decreased visual function but have rarely been reported in the literature, especially bilaterally.
This case report describes a patient with bilateral cecocentral visual field defects due to congenital optic nerve pits without associated maculopathy.
A 42-year-old Black man presented with blur symptoms at near uncorrected. Of note, there was no history of substance abuse or nutritional deficiencies. Best-corrected acuities were 20/20 in the right eye and 20/30 in the left eye. Clinical examination revealed bilateral focal grayish depression of the temporal optic nerve cup with associated papillomacular retinal nerve fiber layer defects. Optical coherence tomography (OCT) imaging revealed bilateral focal excavation of the temporal cup, temporal thinning of the retinal nerve fiber layer, and correlated binasal thinning of the ganglion cell complex, in the absence of retinoschisis or neurosensory detachment. Threshold visual field testing revealed stable bilateral cecocentral visual field defects. A diagnosis of bilateral cecocentral visual field defect secondary to congenital optic disc pits was made based on the patient's history and clinical examination.
A cecocentral visual field defect, unrelated to maculopathy, is a less common complication of congential optic disc pits that can cause decreased visual function. This case report provides evidence of this bilateral ocular condition and reviews the reported clinical, OCT, and threshold visual field manifestations of the disease. Specifically, spectral-domain OCT ganglion cell analysis seems useful in localizing the visual field defect.
先天性视盘凹陷已知会引起并发症，常见的是由于视网膜劈裂和/或神经感觉性视网膜脱离导致的黄斑病变。伴有视野缺损但无黄斑病变的视网膜神经纤维层缺陷是另一种并发症，可导致视功能下降，但在文献中很少报道，尤其是双侧性的。
本病例报告描述了一名因先天性视神经凹陷导致双侧中心暗点性视野缺损且无相关黄斑病变的患者。
一名42岁黑人男性因未矫正时近视力模糊前来就诊。值得注意的是，他没有药物滥用或营养缺乏史。最佳矫正视力右眼为20/20，左眼为20/30。临床检查发现双侧颞侧视神经杯局部灰白色凹陷，伴有视乳头黄斑视网膜神经纤维层缺陷。光学相干断层扫描（OCT）成像显示双侧颞侧杯局部凹陷、视网膜神经纤维层颞侧变薄，以及神经节细胞复合体双侧鼻侧变薄，且无视网膜劈裂或神经感觉性脱离。阈值视野测试显示双侧中心暗点性视野缺损稳定。根据患者病史和临床检查，诊断为先天性视盘凹陷继发双侧中心暗点性视野缺损。
与黄斑病变无关的中心暗点性视野缺损是先天性视盘凹陷较少见的并发症，可导致视功能下降。本病例报告提供了这种双侧眼部疾病的证据，并回顾了该疾病已报道的临床、OCT和阈值视野表现。具体而言，光谱域OCT神经节细胞分析似乎有助于定位视野缺损。
