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PHOTO ESSAY
Year : 2019  |  Volume : 67  |  Issue : 10  |  Page : 1716-1717

Optical coherence tomography angiography in situs inversus of the optic discs


Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India

Date of Submission03-Apr-2019
Date of Acceptance22-Apr-2019
Date of Web Publication23-Sep-2019

Correspondence Address:
Dr. Mohit Dogra
Advanced Eye Centre, PGIMER, Chandigarh, Punjab - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_664_19

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  Abstract 


Keywords: Optical coherence tomography angio, Optical Coherence Tomography Angiography, situs inversus


How to cite this article:
Gupta G, Singh SR, Sharma VK, Dogra M. Optical coherence tomography angiography in situs inversus of the optic discs. Indian J Ophthalmol 2019;67:1716-7

How to cite this URL:
Gupta G, Singh SR, Sharma VK, Dogra M. Optical coherence tomography angiography in situs inversus of the optic discs. Indian J Ophthalmol [serial online] 2019 [cited 2019 Oct 14];67:1716-7. Available from: http://www.ijo.in/text.asp?2019/67/10/1716/267457



A 28-year-old male was referred with a diagnosis of “funny looking” retinal vessels. His unaided visual acuity was 6/6, and anterior segment examination was unremarkable in both eyes. Fundus evaluation showed nasalization of retinal arterioles and venules at the optic discs of both eyes. Retinal vessels were seen emerging from the centre of the optic disc and then coursing supero-nasally and infero-nasally, instead of supero-temporally and supero-nasally. After coursing for 2 disc diameters nasally, they acutely turned temporally and went on to form the vascular arcades. This was more prominent in the left eye than in the right eye, and was suggestive of Situs inversus of the optic discs (SI-OD) [Figure 1]a and [Figure 1]b. The peculiar pattern and course of retinal vessels was better appreciated on the superficial capillary plexus slab of Optical Coherence Tomography Angiography (OCTA) [Figure 2]. Cross-sectional OCT of the macula and optic disc showed hyperreflectivity of the inner retina nasal to the optic discs in both eyes, suggestive of nasalization of the papillomacular bundle [Figure 3]a and [Figure 3]b. OCT of the peripapillary retinal nerve fibre layer (RNFL) showed a thicker nasal RNFL, thinner temporal RNFL and nasally deviated RNFL peak locations compared to the normative database [Figure 3]c and [Figure 3]d.
Figure 1: Fundus photographs showing initial coursing of vessels supero-nasally and infero-nasally after emerging from the disc (green arrows), instead of supero-temporally and supero-nasally, and then they acutely turned temporally (yellow arrows), which is more prominent in left eye (b) than the right eye (a)

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Figure 2: The peculiar pattern of retinal vessels being better appreciated on the superficial capillary plexus slab of Optical Coherence Tomography Angiography in right (a) and left eye (b)

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Figure 3: Cross-sectional OCT of the macula showing hyperreflectivity of the inner retina nasal to the optic discs in both eyes (denoted by yellow arrows), suggestive of nasalization of the papillomacular bundle (a and b). OCT of the optic nerve head showing a thicker nasal retinal nerve fibre layer (RNFL), thinner temporal RNFL and more nasally-located RNFL peak locations (c and d)

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SI-OD is a rare developmental anomaly, where the retinal vessels emerge from the nasal aspect of the disc and course nasally before turning temporally.[1] It is usually bilateral and thought to be caused by anomalous insertion of the optic stalk into the optic vesicle, resulting in dysversion of the nerve head.[2]

It has been reported in patients with tilted optic discs, myopes,  Ehlers-Danlos syndrome More Details, familial dextrocardia and optic neuritis.[2],[3],[4] Although this condition is generally asymptomatic, caution is needed while interpreting OCT RNFL values in these eyes – as they don't conform to normative data of OCT machines.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sen SC, Bhattacharya P, Biswas PN. Situs inversus of the optic disc. Indian J Ophthalmol 1988;36:44-5.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Kothari M, Chatterjee DN. Unilateral situs inversus of optic disc associated with reduced binocularity and stereoacuity resembling monofixation syndrome. Indian J Ophthalmol 2010;58:241-2.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Brodsky MC. Congenital optic disk anomalies. Surv Ophthalmol 1994;39:89-112.  Back to cited text no. 3
    
4.
Sowka J, Aoun P. Tilted disc syndrome. Optom Vis Sci 1999;76:618-23.  Back to cited text no. 4
    
5.
Han SY, Hwang YH. Glaucoma in an eye with situs inversus of the optic disc. Semin Ophthalmol 2014;29:172-4.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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