Rutledge B K, Puliafito C A, Duker J S, Hee M R, Cox M S
New England Eye Center, Tufts University School of Medicine, Boston, MA 02111, USA.
Ophthalmology. 1996 Jul;103(7):1047-53. doi: 10.1016/s0161-6420(96)30568-x.
Although optic pits were described more than a century ago, the pathogenesis and pathologic nature of the associated macular lesions remain controversial. The authors used the technique of optical coherence tomography (OCT) to further define the anatomic relation that exists between optic pits, macular schisis-like spaces, and macular detachments.
Four eyes of three consecutive patients with optic pit-related macular pathology were evaluated. Cross-sectional OCT images were correlated with findings from slit-lamp biomicroscopy and stereo fundus photography. All eyes previously had undergone unsuccessful photocoagulation to the temporal juxtapapillary retina. One eye had undergone vitrectomy and intraocular gas tamponade, resulting in partial resorption and displacement of the submacular fluid.
Retinal edema and cystic degeneration were present, overlying macular neurosensory detachments in all four eyes. The most prominent edema was present in the outer retina at the level of the outer plexiform layer. This mimicked a true retinoschisis cavity, although bridging retinal elements were identifiable. A lesser degree of edema was present in the inner retina, predominantly located between the disc and fovea. In one eye, a lamellar hole was shown to be a defect in the outer neurosensory retina. In another eye, a macular detachment developed under a pre-existing schisis-like cavity. The schisis-like cavity or edematous retina communicated with the optic disc in all eyes, whereas none of the eyes demonstrated a direct connection between the macular detachment and optic pit.
These findings support the concept of a bilaminar structure in which a macular detachment develops secondarily to a pre-existing schisis-like lesion consisting of severe outer retinal edema. Fluid may enter from the optic pit into the retinal stroma and not directly into the subretinal space, explaining the prolonged recovery and frequency of treatment failure after photocoagulation to the juxtapapillary retina.
尽管视盘小凹在一个多世纪前就已被描述，但相关黄斑病变的发病机制和病理性质仍存在争议。作者使用光学相干断层扫描（OCT）技术进一步明确视盘小凹、黄斑劈裂样间隙和黄斑脱离之间存在的解剖关系。
对连续3例患有视盘小凹相关黄斑病变患者的4只眼进行评估。将横断面OCT图像与裂隙灯生物显微镜检查和立体眼底照相的结果进行对比。所有眼睛此前对颞侧近乳头视网膜进行光凝治疗均未成功。1只眼曾接受玻璃体切除术和眼内气体填塞，导致黄斑下液部分吸收和移位。
所有4只眼中均存在视网膜水肿和囊性变性，黄斑神经感觉层脱离。最明显的水肿出现在外丛状层水平的外层视网膜。这类似于真正的视网膜劈裂腔，尽管可识别出连接视网膜的结构。内层视网膜存在较轻程度的水肿，主要位于视盘和黄斑中心凹之间。在1只眼中，一个板层裂孔显示为外层神经感觉视网膜的缺损。在另一只眼中，在一个先前存在的劈裂样腔内发生了黄斑脱离。所有眼中劈裂样腔或水肿的视网膜均与视盘相通，而没有一只眼显示黄斑脱离与视盘小凹之间存在直接连接。
这些发现支持双层结构的概念，即黄斑脱离继发于先前存在的由严重外层视网膜水肿构成的劈裂样病变。液体可能从视盘小凹进入视网膜基质，而不是直接进入视网膜下间隙，这解释了对近乳头视网膜进行光凝治疗后恢复时间延长和治疗失败频率较高的原因。
