๐ข๐ฝ๐๐ถ๐ฐ ๐๐ถ๐๐ฐ ๐ฃ๐ถ๐ ๐ ๐ฎ๐ฐ๐๐น๐ผ๐ฝ๐ฎ๐๐ต๐โฃ
โฃ
Macular changes that occur secondary to optic disc pit include intraretinal and subretinal fluid accumulationโฃ
Occurs in 25-75%โฃ
Usually occurs at 30-40 years of ageโฃ
More common when the pit is located temporally โฃ
โฃ
๐๐ฐ๐ถ๐ณ ๐ฑ๐ฐ๐ด๐ด๐ช๐ฃ๐ญ๐ฆ ๐ด๐ฐ๐ถ๐ณ๐ค๐ฆ๐ด ๐ง๐ฐ๐ณ ๐ต๐ฉ๐ฆ ๐ง๐ญ๐ถ๐ช๐ฅ:โฃ
โฃ
1. Vitreousโฃ
2. Cerebrospinal fluid through the defectโฃ
3. Leakage from blood vessels at the pitโฃ
4. Choroid through the Bruchโs membrane and peripapillary atrophyโฃ
โฃ
๐๐ข๐ต๐ฉ๐ฐ๐ฑ๐ฉ๐บ๐ด๐ช๐ฐ๐ญ๐ฐ๐จ๐บ ๐ช๐ด ๐ค๐ฐ๐ฏ๐ต๐ณ๐ฐ๐ท๐ฆ๐ณ๐ด๐ช๐ข๐ญ:โฃ
โฃ
1. Vitreous tractionโฃ
2. Pressure gradients within the eye cause migration of fluid from the vitreous into theโฃ
subretinal spaceโฃ
โฃ
โฃ
๐๐ฆ๐ฒ๐ถ๐ฆ๐ฏ๐ค๐ฆ ๐ฐ๐ง ๐ณ๐ฆ๐ต๐ช๐ฏ๐ข๐ญ ๐ง๐ญ๐ถ๐ช๐ฅ ๐ข๐ค๐ค๐ถ๐ฎ๐ถ๐ญ๐ข๐ต๐ช๐ฐ๐ฏ ๐ข๐ฏ๐ฅ ๐ฑ๐ณ๐ฐ๐จ๐ณ๐ฆ๐ด๐ด๐ช๐ฐ๐ฏ:โฃ
โฃ
1. Fluid from the pit creates a schisis-like inner retinal separation, associated with a mild centrocecal scotomaโฃ
2. Then, an outer layer macular hole develops beneath the inner layer, associated with a dense central scotomaโฃ
3. The fluid then dissects subretinally creating an outer retinal detachment.โฃ
4. OCT also supports the concept that the fluid first enters the inner retinal layers and onlyโฃ later makes its way to the subretinal spaceโฃ
5. It has been suggested that as fluid accumulates intraretinally and a pressure gradient isโฃ formed that is directing it into the retina and to the subretinal spaceโฃ
โฃ
๐๐ณ๐ฆ๐ข๐ต๐ฎ๐ฆ๐ฏ๐ต:โฃ
โฃ
1. Observe upto 3 months for spontaneous resolution which can occur in 25% of the casesโฃ
2. Laser photocoagulation to temporal margin of the disc- laser scars will create aโฃ
chorioretinal adhesion which will act as a barrier between the ODP and the subretinalโฃ
spaceโฃ
3. Pars plana vitrectomy with induction of PVD and gas tamponade, ILM peeling is done by some surgeonsโฃ
4. Macular bucklingโฃ
โฃ
www.ophthalmobytes.comโฃ
โฃ
Image from Rajan Eye Care Hospitalโฃ
1. Optic disc pit
2. Fluid at the macula
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Reference: https://doi.org/10.1186/s40942-015-0013-8