case_images: PMC10987180_01
case_images: a Wide angle fundus photograph of the right eye shows diffuse disc edema and choroidal folds (white arrow). b Wide angle fundus photograph of the left eye demonstrates a small optic disc and choroidal fold (white arrow). c A 12 mm horizontal OCT scan of the right macula reveals absence of foveal depression (yellow star), peripapillary retinoschisis (white arrowhead), disc edema, buried disc drusen (yellow arrowheads), undulated retinal pigment epithelium (white lines), diffusely thickened choroid, and dome-shaped peripapillary area (red arrow). d A 12 mm horizontal OCT scan of the left macula shows a small disc size (1,008 mum), absence of foveal depression (yellow star), diffusely thickened choroid and dome-shaped peripapillary area (red arrows) and subtle choroidal folds (white line). e, f Automated visual fields revealed a central scotoma in the right eye.
case_images: cop-2024-0015-0001-537829_F01.jpg
case_images: PMC10987180_01_cop-2024-0015-0001-537829_F01.jpg
case_images: F1
case_images: Exam results showed an elevated disc with telangiectatic vessels in the right eye and a small optic disc in the left eye, as shown in Figure 1. In the right eye's visual fields, a significant central scotoma is visible in Figure 1.
case_images: a-f Operative sequences. Sclerectomy is initiated with a hockey blade behind the rectus muscle insertion in each quadrant by incising the thick sclera very deep till a violaceous hue appears. Then the flap is pulled up and the dissection is continued along the same plane using a bevelled crescent knife. g Following circumferential sclerectomy, radial nasal sclerectomy is also done reaching the optic nerve head sheath. This allowed resolution of the optic disc edema and a decreased peripapillary choroidal thickness as seen in Figure 3.
case_images: cop-2024-0015-0001-537829_F02.jpg
case_images: PMC10987180_01_cop-2024-0015-0001-537829_F02.jpg
case_images: F2
case_images: The sclera behind the recti was severely thickened (2.5-3 mm) (Fig. 2). In addition, a nasal posterior radial sclerectomy reaching the optic nerve sheath is shown in Figure 2.
case_images: a Complete resolution of the right disc edema is visible on fundus photography 20 days postoperatively. Baseline (b) and at 2-month post-surgery (c) horizontal OCT scan through the right disc revealed dome-shaped peripapillary area (white arrow). The peripapillary choroidal thickness decreased from 726 microm to 645 microm. d The two discs have comparable nerve fiber layer analysis denoting no permanent damage from the compressive optic neuropathy, aside from subtle superior temporal and inferior temporal thickness asymmetry.
case_images: cop-2024-0015-0001-537829_F03.jpg
case_images: PMC10987180_01_cop-2024-0015-0001-537829_F03.jpg
case_images: F3
case_images: Two weeks postoperatively, there was full recovery of vision (20/40 both eyes), color perception (10/10 color plates both eyes), and resolution of disc edema in the right eye (Fig. 3).