Optic disc pit maculopathy
Optic pits are thought to be a result of incomplete closure of the superior edge of the embryonic fissure. The mechanisms of SRF in optic disc pit maculopathy are not well understood. It has been postulated that the fluid may arise from one of several sources; the vitreous cavity, cerebrospinal fluid (CSF), the surrounding orbital space or dural leaking vessels at the base of the pit .
As for the theory suggesting the fluid arising from vitreous cavity, pre-existing vitreous traction on the macula and the optic disc is thought to play a role in the development of negative pressure with subsequent entrance of fluid through the ODP into the submacular space. Whereas, the theory of CSF leaking into the macular schisis or subretinal space is thought to be from a direct communication of the subarachnoid space through the ODP that transmits fluid into the intra- and subretinal space.
Optic pits are generally found inferotemporally within the nerve, however up to one-third are central. They appear as a round or oval depression that differs in color from the surrounding disc (grey, yellow or black). There may associated macular edema, serous macular detachment; schisis or pigmentary changes within the macula.
Investigations are usually done to diagnose, and to detect complications. Sub-retinal fluid, or macular schisis are complications that can be detected with a macular OCT. Moreover, investigations are used to monitor for the success of treatment. ODP can present with visual field deficits such as arcuate scotoma, central scotoma or an enlarged blind spot.
Management:
Laser photocoagulation temporal to the optic disc
Pars plana vitrectomy +/- ILM peeling, +/- endolaser +/- gas tamponade.
Pars plana vitrectomy with inverted ILM flap to cover the optic disc pit
Inner retinal fenestrations
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