Optical Coherence Tomography Findings in the Junctional Scotoma of Traquair

Photo Essay Section Editors: Melissa W. Ko, MD Dean M. Cestari, MD Peter Quiros, MD Optical Coherence Tomography Findings in the Junctional Scotoma of Traquair Shruthi Harish Bindiganavile, MD, Nita Bhat, MD, Ore-Ofeoluwatomi Adesina, MD, Andrew G. Lee, MD Downloaded from http://journals.lww.com/jneuro-ophthalmology by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 05/04/2022 FIG. 1. T2 coronal MRI showing a sellar mass with suprasellar extension compressing on the inferior nasal crossing fibers on the right producing the superotemporal monocular visual field defect in the right eye (i.e., the junctional scotoma of Traquair). Abstract: A 43-year-old woman presented with a right-sided visual field defect in the right eye. The visual acuity was normal and there was a right relative afferent pupillary defect. Formal visual field testing revealed a junctional scotoma of Traquair. The fundus examination showed optic atrophy in the right eye and optical coherence tomography demonstrated unilateral band atrophy. Neuroimaging revealed a sellar and suprasellar cystic pituitary adenoma for which she underwent a transsphenoidal drainage. We demonstrate the clinical and radiographic features of the Department of Ophthalmology (SHB, NB, AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Ruiz Department of Ophthalmology and Visual Sciences (O-OA), Houston, Texas; The Houston Methodist Research Institute (AGL), Houston Methodist Hospital, Houston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery (AGL), Weill Cornell Medicine, New York, New York; Department of Ophthalmology (AGL), University of Texas Medical Branch, Galveston, Texas; University of Texas MD Anderson Cancer Center (AGL), Houston, Texas; Texas A and M College of Medicine (AGL), Bryan, Texas; and Department of Ophthalmology (AGL), The University of Iowa Hospitals and Clinics, Iowa City, Iowa. The authors report no conflicts of interest. Address correspondence to Andrew G. Lee, MD, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin Street, Suite 450, Houston, TX 77030; Email: [e-mail] Harish Bindiganavile et al: J Neuro-Ophthalmol 2021; 41: e111-e113 junctional scotoma of Traquair and describe the differentiating features vs the junctional scotoma. Journal of Neuro-Ophthalmology 2021;41:e111–113 doi: 10.1097/WNO.0000000000000972 © 2020 by North American Neuro-Ophthalmology Society A 43-year-old Filipino woman presented to the neuroophthalmology clinic with visual loss. Medical history was significant for hypertension. MRI of the sella showed a suprasellar mass compressing the right side of the optic chiasm at the junction (Fig. 1). Prolactin level was slightly elevated at 33 ng/mL (normal less than 29 ng/mL), consistent with pituitary stalk effect. Follicular stimulating hormone, luteinizing hormone, Free T3, thyroid stimulating hormone, morning and random cortisol levels, and adrenocorticotrophic hormone levels were normal. Her visual acuity was 20/20 in both the eyes. There was a right relative afferent pupillary defect. Humphrey visual field testing (24-2) Swedish Interactive Threshold Algorithm (SITA) perimetry showed a monocular, partial temporal hemianopic pattern of field defect in the right eye (Fig. 2) with corresponding nasal fiber loss on optical e111 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Photo Essay FIG. 2. Humphrey visual field 24-2 SITA showing right-sided monocular temporal field defect (i.e., junctional scotoma of Traquair). coherence tomography (OCT) scan of the retinal nerve fiber layer resulting from a prechiasmal compression of nasal crossing fibers (band atrophy) (Fig. 3). There was mild nonspecific superior temporal and inferonasal depression but a normal peripapillary retinal nerve fiber layer in the left eye (Fig. 3). FIG. 3. Optical coherence tomography (OCT) shows corresponding nasal retinal nerve fiber loss (monocular band atrophy). e112 Harish Bindiganavile et al: J Neuro-Ophthalmol 2021; 41: e111-e113 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Photo Essay The anterior chiasmal syndrome can present with 2 types of junctional visual field loss (1,2). The junctional scotoma of Traquair (JST) is named after Harry Moss Traquair, a Scottish ophthalmologist known for his contributions to the field of perimetry in the year 1957 (3). The JST refers to a monocular hemianopic field defect, which can be nasal or temporal hemianopic visual field loss (1). By contrast, the junctional scotoma (JS) refers to ipsilateral central field loss in one eye and contralateral superotemporal field loss from involvement of ipsilateral optic nerve fibers and crossing inferior nasal fibers from the opposite side. These visual field defect patterns are possible from anatomical variations of the chiasm in relationship to the pituitary and because of varying directions of lesion growth. Although bitemporal hemianopsia is the most frequently reported field defect with pituitary adenoma, junctional visual field loss including JST and JS is found in up to 1%–10% of the cases (4,5). Neuroimaging should be performed in any patient presenting with junctional visual field loss. The fundus examination and OCT may show band (nasal) optic atrophy and retinal nerve fiber layer loss. Band atrophy of the optic nerve head has been reported with the JS (6). To the best of our knowledge, this is the first report of the OCT evidence of monocular band atrophy along with clinical and radiographic findings in a patient with the JST. Harish Bindiganavile et al: J Neuro-Ophthalmol 2021; 41: e111-e113 STATEMENT OF AUTHORSHIP Category 1: a. Conception and design: S. Harish Bindiganavile and A. G. Lee; b. Acquisition of data: S. Harish Bindiganavile and O.-O. Adesina; c. Analysis and interpretation of data: S. Harish Bindiganavile and N. Bhat. Category 2: a. Drafting the manuscript: S. Harish Bindiganavile and A. G. Lee; b. Revising it for intellectual content: A. G. Lee and O.-O. Adesina. Category 3: a. Final approval of the completed manuscript: S. Harish Bindiganavile, N. Bhat, O.-O. Adesina, and A. G. Lee. REFERENCES 1. Lee AG. Acromegaly and junctional visual field loss. Ophthalmology. 2001;108:832–833. 2. Horton JC. Wilbrand’s knee of the primate optic chiasm is an artefact of monocular enucleation. Trans Am Ophthalmol Soc. 1997;95:579–609. 3. Grzybowski A. Harry Moss traquair (1875–1954), scottish ophthalmologist and perimetrist. Acta Ophthalmol (Copenh). 2009;87:455–459. 4. Elkington SG. Pituitary adenoma. Preoperative symptomatology in a series of 260 patients. Br J Ophthalmol. 1968;52:322–328. 5. Mojon DS. Pituitary adenoma revealed by paracentral junctional scotoma of traquair. Ophthalmologica. 1997;21:104–108. 6. Scruggs BA. Thurtell M Bow-tie (band) atrophy secondary to compressive optic neuropathy (Eyerounds.org website) Available at: https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/ bow-tie-atrophy.htm. Accessed June 1, 2018. e113 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.