𝗢𝗽𝘁𝗶𝗰 𝗗𝗶𝘀𝗰 𝗣𝗶𝘁 𝗠𝗮𝗰𝘂𝗹𝗼𝗽𝗮𝘁𝗵𝘆
Macular changes that occur secondary to optic disc pit include intraretinal and subretinal fluid accumulation
Occurs in 25-75%
Usually occurs at 30-40 years of age
More common when the pit is located temporally
𝘍𝘰𝘶𝘳 𝘱𝘰𝘴𝘴𝘪𝘣𝘭𝘦 𝘴𝘰𝘶𝘳𝘤𝘦𝘴 𝘧𝘰𝘳 𝘵𝘩𝘦 𝘧𝘭𝘶𝘪𝘥:
1. Vitreous
2. Cerebrospinal fluid through the defect
3. Leakage from blood vessels at the pit
4. Choroid through the Bruch’s membrane and peripapillary atrophy
𝘗𝘢𝘵𝘩𝘰𝘱𝘩𝘺𝘴𝘪𝘰𝘭𝘰𝘨𝘺 𝘪𝘴 𝘤𝘰𝘯𝘵𝘳𝘰𝘷𝘦𝘳𝘴𝘪𝘢𝘭:
1. Vitreous traction
2. Pressure gradients within the eye cause migration of fluid from the vitreous into the
subretinal space
𝘚𝘦𝘲𝘶𝘦𝘯𝘤𝘦 𝘰𝘧 𝘳𝘦𝘵𝘪𝘯𝘢𝘭 𝘧𝘭𝘶𝘪𝘥 𝘢𝘤𝘤𝘶𝘮𝘶𝘭𝘢𝘵𝘪𝘰𝘯 𝘢𝘯𝘥 𝘱𝘳𝘰𝘨𝘳𝘦𝘴𝘴𝘪𝘰𝘯:
1. Fluid from the pit creates a schisis-like inner retinal separation, associated with a mild centrocecal scotoma
2. Then, an outer layer macular hole develops beneath the inner layer, associated with a dense central scotoma
3. The fluid then dissects subretinally creating an outer retinal detachment.
4. OCT also supports the concept that the fluid first enters the inner retinal layers and only later makes its way to the subretinal space
5. It has been suggested that as fluid accumulates intraretinally and a pressure gradient is formed that is directing it into the retina and to the subretinal space
𝘛𝘳𝘦𝘢𝘵𝘮𝘦𝘯𝘵:
1. Observe upto 3 months for spontaneous resolution which can occur in 25% of the cases
2. Laser photocoagulation to temporal margin of the disc- laser scars will create a
chorioretinal adhesion which will act as a barrier between the ODP and the subretinal
space
3. Pars plana vitrectomy with induction of PVD and gas tamponade, ILM peeling is done by some surgeons
4. Macular buckling
www.ophthalmobytes.com
Image from Rajan Eye Care Hospital
1. Optic disc pit
2. Fluid at the macula
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Reference: https://doi.org/10.1186/s40942-015-0013-8