Myopic Peripapillary Sinkhole: Prolapse of Retinal Nerve Fiber Layer and Posterior Vitreous Into a Sclerochoroidal Hollow Causing Peripapillary Choroidal Thickening and Cavitation

Figure 1. The evolution of a myopic peripapillary sinkhole associated with peripapillary choroidal thickening and cavitation. A, Baseline disc photograph of the left eye in 1984. B, The 1987 disc photograph reveals the telltale sign of the sinkhole process, a gradually sinking peripapillary vessel (asterisk). Arrow indicates the companion atrophic hole in the retinal nerve fiber layer. C, A nearby disc hemorrhage (arrow) is seen in the 1988 photograph. D, The crescent-shaped yellow-orange lesion (arrows) is peripapillary choroidal thickening and cavitation, recently renamed by Freund et al.³

Figure 2. Cirrus high-definition optical coherence tomography 3 (Carl Zeiss Meditec) analysis of a myopic peripapillary sinkhole. A, Topographical 3-dimensional analysis of the right eye shows normal surface peripapillary anatomy with the upper and lower pole of the disc indicated by arrows. B, The curved arrow in the left eye indicates a deep inferotemporal peripapillary depression; the optic nerve poles are located between the straight arrows. The depression may also extend inferiorly between the arrowheads, indicating localized loss of the retinal nerve fiber layer. C, Cross-sectional analysis reveals prolapsed retinal nerve fiber layer tissue (arrows), between which is the retinal hole. Diamond indicates the optically empty sclerochoroidal cavity. The inferior margin of the disc (lower arrowhead) appears to be on a much lower plane than the rest of the disc margin (upper arrowhead). D, The enhanced choroidal view of the left eye reveals the dark area below the disc (arrow), an area with loss of reflectivity, that likely represents prolapsed liquid vitreous. E, Horizontal raster line analysis through the inferotemporal sinkhole. The broad depression shows a hole (arrow) in the prolapsed tissue that communicates to the underlying sclerochoroidal cavity occupied by an optically empty substance, presumably liquid vitreous.