Pit to fluid!


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

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