Papillary fossette is a rare congenital disorder caused by a developmental defect of the optic nerve head in the development of the lamina cribrosa, through which the neural tissue of the papilla herniates and is covered by a membrane of glial tissue.
The fundus shows a rounded depression, usually at the temporal border of the papilla, with a grayish appearance.
What symptoms are caused by papillary pitting?
They are usually asymptomatic, except for occasional scotomas caused by the lack of nerve fibers in that area, and do not usually have associated complications. The main complication they can cause is the passage of fluid into or under the retina, causing macular retinoschisis and even serous retinal detachment.
What causes papillary pitting?
There are several theories about the origin of this fluid, although none of them has been completely proved.
One of them defends that the fluid comes from the vitreous cavity, accessing the subretinal space through tractions or holes at the level of the glial tissue covering the septum.
Another main theory argues that it is cerebrospinal fluid coming from the subarachnoid space, passing into the intraretinal space first (causing macular retinoschisis) through the lamina cribrosa defect and then into the subretinal space through microholes in the outer retina.
What is the treatment for papillary pitting?
Papillary fossette has no treatment as such, what are treated are its complications. The treatment to be followed, therefore, depends on the complications that arise.
In case the patient feels no symptoms and has no retinoschisis or it is scarce and stable, the first option is observation, although it must be taken into account that the probability of worsening is high, so the developmental defect of the optic nerve head specialist in Ophthalmology will perform a close follow-up.
In case of symptomatic retinoschisis or retinal detachment, the main treatment options today are:
- Argon laser on the papillary border.
- Vitrectomy with removal of posterior hyaloid (as the most widespread technique).
- Endophotocoagulation with argon laser at the papillary border and gas