Purpose Eyes with glaucoma often present modification of the lamina cribrosa, including posterior displacement, thinning, defects and pore deformities. Methods A 40-year-old woman with no past medical history have been seen for an acute blurred vision of her left eye 5 days ago. Anamnesis didn't find any family history of glaucoma, but she described a Raynaud phenomenon. Complete ophthalmoscopic examination was performed, with biomicroscopy, fundus imaging, visual field test (Humphrey field analysis 30-2), optical coherence tomography (OCT) assessment with both Spectralis (Heidelberg) and Cirrus OCT (Carl Zeiss), ultrasonography and fluorescein/infracyanin angiography. Results The maculopathy was characterized by schisis-like thickening and serous detachment. The presence of lamina cribrosa defects permits anomalous communications between intraocular and extraocular spaces. OCT showed a schisis cavity between the inner and outer retina and a larger outer-layer retinal detachment. The two were connected by a hole in the outer layer near the fovea. The associated subretinal and intraretinal fluid may derive from cerebrospinal fluid that passes through the opening created by the discontinuity of the lamina cribrosa into the subarachnoidal space. This complication usually occurs in case of congenital optic pit. Conclusions We describe the case of a patient with a recent diagnosis of normal tension glaucoma, showing a pit-like structure within the ONH. We observed focal areas of laminar holes in the superior pole of the optic disc. This location differs from the congenital and acquired optic pits mostly temporally or inferiorly located. Enhanced Depth Imaging OCT of the ONH enables microstructural evaluation of lamina cribrosa defects, especially helpful in case of normal tension glaucoma.
The present paper describes a case of bilateral panuveitis due to Borrelia burgdorferi sensu lato diagnosed by a PCR approach using cerebral spinal fluid. Since the culture of B. burgdorferi takes a long time to grow and the accuracy of serological tests is doubtful in patients, the PCR method of amplifying a B. burgdorferi flagellin could be suitable to make a positive diagnosis in a case of atypical clinical history of Lyme disease.
