Myopic Peripapillary Sinkhole: Prolapse of Retinal Nerve Fiber Layer and Posterior Vitreous Into a Sclerochoroidal Hollow Causing Peripapillary Choroidal Thickening and Cavitation | Ophthalmology | JAMA Ophthalmology | JAMA Network
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Dynamic 3-dimensional optical coherence tomographic reconstruction of a myopic peripapillary sinkhole.

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Research Letter
Sep 2012

Myopic Peripapillary Sinkhole: Prolapse of Retinal Nerve Fiber Layer and Posterior Vitreous Into a Sclerochoroidal Hollow Causing Peripapillary Choroidal Thickening and Cavitation

Author Affiliations

Author Affiliations: Glaucoma Associates of Texas, Dallas.

Arch Ophthalmol. 2012;130(9):1220-1221. doi:10.1001/archophthalmol.2012.441

The pathogenesis of peripapillary choroidal thickening and cavitation, a yellow-orange, dome-shaped lesion inferotemporal to the myopic conus, is unknown.1,2 Some investigators believe the anomaly is congenital in origin owing to the presence of a cleftlike communication between the retina and choroid with vitreous prolapse and anomalous vessels.3 However, we observed a case that developed similar findings but due to a different cause, the gradual sinking of peripapillary retinal tissue into a sclerochoroidal cavity associated with retinal hole formation and posterior vitreous prolapse, newly termed myopic peripapillary sinkhole.

A 63-year-old myopic man was first evaluated in 1984 for pigment dispersion syndrome and suspicious optic discs. Owing to the appearance of the disc and a visual field defect in his left eye, topical antiglaucoma therapy was initiated with betaxolol hydrochloride, 0.25%, twice daily and the intraocular pressure remained between 13 and 16 mm Hg over several decades. Serial disc photographs in the left eye between 1984 (baseline) and 1994 revealed the gradual collapse and ultimate disappearance of a peripapillary retinal vessel associated with an enlarging retinal hole, adjacent disc hemorrhages, and the development of a yellow-orange peripapillary lesion (Figure 1).

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