EC Ophthalmology

Introduction: Optic disc pits (ODPs) are a rare congenital anomaly of the optic disc. They are thought to be a result of incomplete closure of the superior edge of the embryonic fissure. The main complication is the serous maculopathy: optic disc pit maculopathy (OPDM). We present an unusual case of patient with ODPM.

Aim: Underline a rare cause of serous maculopathy and discuss its treatment options.

Observation: 25-year-old patient, male, previously healthy who consults for rapidly progressive vision loss on his right eye quantified at 1/10.

Results: The fundus examination objectified a deeply pigmented circular hole in the inferotemporal neuroretinal rim of the optic nerve.

Macular OCT showed splitting within the neurosensory retina, intraretinal cysts suggesting a retinoschisis with a serous macular detachment.

A pars plana vitrectomy was done with intravitreal injection of gas and peeling of the internal limiting membrane (ILM).

On follow up examinations, a visual improvement was noted, restoration of foveal outer retinal layer structure and diminution of intraretinal fluid.

Discussion: One of the initial treatments was oral corticosteroids and acetazolamide. This treatment proved ineffective in a majority of cases.

Others reports described treating ODPM with argon laser photocoagulation at the temporal disc margin. The time for improvement was often long. Intravitreal gas injection has been proposed. The pneumatic displacement will cause reattachment of the macula.

The majority of the published literature on ODPM favors pars plana vitrectomy (PPV) as the treatment of choice. Several reports described successful anatomical and visual restoration in patients with ODPM who underwent PPV with or without ILM peel, endolaser and gas tamponade.

In our case, a PPV was done with intravitreal injection of gas and peeling of the ILM. A visual improvement was noted, restoration of foveal outer retinal layer structure was documented by OCT and diminution of intraretinal fluid.

Conclusion: The mechanism of pathogenesis of the subretinal fluid in OPDM been reached. This makes it difficult to determine the optimal surgical technique. Typically, ODPM is treated with PPV with or without juxtapapillary retinal laser photocoagulation, gas tamponade and ILM peeling.

Keywords: Optic Disc Pit Maculopathy; Treatment; Vitrectomy