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Optic Disc Doubling

Padhi, Tapas Ranjan MS; Samal, Bikash BSc (Optom); Kesarwani, Siddharth MS; Basu, Soumyava MS; Das, Taraprasad FRCS

Section Editor(s): McCulley, Timothy J. MD

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Journal of Neuro-Ophthalmology: September 2012 - Volume 32 - Issue 3 - p 238-239
doi: 10.1097/WNO.0b013e3182464d9f
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Abstract

Many developmental defects can simulate the optic disc (optic disc pseudodoubling) including peripapillary coloboma and scarring (1–3). True optic disc duplication with 2 independent retinal vasculatures is rare (4).

We document such a case in the asymptomatic left eye of a 41-year-old man (Fig. 1). Visual acuity was 20/20 bilaterally, and pupillary reactions were normal, as were anterior segment examinations and the right fundus appearance. The patient's general health was excellent, and medical history was unremarkable.

FIG. 1
FIG. 1:
A. The left optic disc has an intact neuroretinal rim (C/D ratio = 0.5), but the inferotemporal venular trunk is absent. More inferiorly, there is a rudimentary optic disc and an area of retinal pigment epithelial atrophy that bridges the 2 discs. There is a single foveal avascular zone corresponding to the true optic disc at a level slightly lower than normal with a macular pigment epithelial detachment. The inferotemporal portion of the perifoveal capillary net is formed by tributaries from the superotemporal vascular arcade of the rudimentary disc. B and C. Fundus fluorescein angiogram of the left eye showing simultaneous and similar filling patterns of both the main and accessory vascular systems with pooling in the pigment epithelial detachment. D. Automated visual field of the left eye demonstrating an additional blind spot corresponding to the rudimentary disc with a contiguous arcuate scotoma superiorly. E. Optical coherence tomography line scan, passing obliquely across both optic discs, showing 2 craters of similar configuration but different depths. F. B-scan ultrasound of the left eye showing a single optic nerve shadow; a second optic nerve was not detected in additional planes. The patient declined orbital MRI.

REFERENCES

1. Islam N, Best J, Mehta JS, Sivakumar S, Plant GT, Hoyt WF. Optic disc duplication or coloboma? Br J Ophthalmol. 2005;89:26–29.
2. Young S, Ng JK, Gaynon MW. Pseudo duplication of the optic disk. Retinal Cases & Brief Reports. 2011;5:144–145.
3. Barboni P, Deluigi M, Bonis CD, Monetti G, Savini G, Zanini M. Pseudodoubling of the optic disc. Arch Ophthalmol. 1998;116:1400–1401.
4. Lamba PA. Doubling of the papillae. Acta Ophthalmologica. 1969;47:4–9.
© 2012 Lippincott Williams & Wilkins, Inc.