Preserved retinal sensitivity in spatial correspondence to an intrachoroidal cavitation area with full thickness retinal defect: a case report
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Intrachoroidal cavitation (ICC) in the temporal peripapillary area is a relatively frequent finding in high myopia. However, ICC associated with a full thickness retinal defect rarely observed. We report an unusual case of ICC combined with a full thickness retinal defect in the papillo-macular bundle, in which the spatially corresponding visual field sensitivity was preserved.
A high myopic and pseudophakic left eye of a 79-year-old Japanese woman was evaluated with swept source optical coherence tomography (SS-OCT) and Humphrey 30-2 visual field testing for moderate glaucoma. The best-corrected visual acuity was 20/20, the axial length was 28.77 mm, the mean deviation -8.94 dB, and the intraocular pressure was 15 mmHg without medication. The horizontal SS-OCT scans showed a wide ICC with a full thickness retinal defect in the papillo-macular area at the outer border of the myopic peripapillary beta zone atrophy. The retina was herniated into the ICC area. While no sensitivity loss was seen in the central visual field corresponding to the full thickness retinal defect, a glaucomatous visual field deterioration spatially corresponding to the glaucomatous disc damage was present. The preserved retinal sensitivity spatially corresponding to the full thickness retinal defect was confirmed with microperimetry.
Our case suggests that retina herniated in peripapillary ICC temporal to the disc may preserve some function despite the presence of a retinal defect.
KeywordsGlaucoma High myopia Intrachoroidal cavitation Perimetry Retinal defect Retinal nerve fiber layer Visual field
Swept source optical coherence tomography
On retinal photography and with clinical evaluation of the retina peripapillary intrachoroidal cavitation (ICC) typically appears as an area surrounded by a yellowish–orange lesion that is located inferior or temporal to the optic disc in highly myopic eyes [1, 2]. Several case reports were published on ICC [1, 2, 3, 4, 5], and there have been reports on ICC case associated with a full thickness retinal defect [3, 5]. It has been shown that a glaucomatous visual field defect is also typically seen in ICC, although a causal relationship between ICC (with or without a retinal defect) and the visual field sensitivity loss has not been established . We report on an unusual case of temporal peripapillary ICC associated with retinal herniation and full thickness retinal defect with preserved retinal sensitivity in the corresponding central visual field.
Discussion and conclusions
ICC is common in pathological myopia and visual field defects are typical in eyes with ICC. However, association of ICC and a full thickness retinal defect in the area of the papillo-macular nerve fiber bundle has not yet been published. In one investigation 71 % of eyes with ICC showed a glaucomatous visual field defect . Ohno-Matsui et al.  reviewed the medical records of 125 pathological myopia patients whose papillary and peripapillary regions were examined with SS-OCT. Sixteen of the 125 patients (12.8 %) were found to have a temporal ICC. In addition, an inner retinal defect was observed in 2 of the 16 patients. Though, our case is typical in terms of clinical characteristics (high myopia in the background; ICC location temporal to the disc; and typical clinical appearance of the ICC) it is unusual due to the association of ICC and a full thickness retinal defect in the papillo-macular bundle area; and the lack of association of the full thickness retinal defect with any spatially corresponding functional loss in the central visual field and in microperimetry of the macula. Since preservation of retinal function was confirmed with two different functional tests (perimetry and microperimetry); the visual field was reliable; and the coexisting glaucomatous visual field deterioration was correctly detected, we think that the preservation of visual function corresponding with the papillo-macular bundle is a valid finding. As far as we know this is the first report in which preserved retinal sensitivity, confirmed with two different methods is seen in ICC associated with a full thickness retinal defect. We suppose that the herniated retina maintained some of its function in the papillo-macular area despite the full thickness damage, which may suggest a relatively a recent development of the ICC. Since the time course of the development of functional deterioration due to ICC formation is unknown further prospective investigations are proposed to clarify the relationship between ICC formation and corresponding perimetric function.
Availability of data and materials
The dataset supporting the conclusions of this article is included within the article.
YK drafted this manuscript, collected the data, and reviewed the literature. MI and GH drafted this manuscript and reviewed the literature. RK, MS and AH critically reviewed the manuscript finally. All authors read and approved the final manuscript.
Gábor Hollό is a consultant of Optovue, Inc. and Carl Zeiss Meditec, Inc.
The authors declare that they have no competing interests.
Consent for publication
The patient has given a written consent for the publication of this report.
Ethics approval and consent to participate
Procedures followed the tenets of Declaration of Helsinki, with the retrospective protocol approved by the Institutional Review Board for Human Research of the Kyorin University.
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