Optic Disc Pit With Serous Macular Detachment May Require Combined Procedures

Optic disc pit (ODP), a rare congenital anomaly of the optic nerve, can be coupled with conditions such as maculopathy. But when patients with ODP also have serous macular detachment, the risk of visual impairment increases. These cases may require multiple approaches, both medical and surgical, to preserve vision. A case report presented at the ePosters session of the American Optometric Association’s annual conference, Optometry’s Meeting, reviews the protocols employed by a 35-year-old patient with this presentation.

The poster shows the exam findings for the left eye of a 35-year-old woman of Black ethnicity with no prior medical or ocular history. The patient complained of distorted vision in her left eye that initiated 3 days before presentation. Her initial examination showed an unremarkable anterior segment and no leakage on fluorescein angiography. However, optical coherence tomography (OCT) imaging showed significant subretinal fluid extending from the optic nerve head, which had a large, temporal ODP. She also was found to have subfoveal fluid tracking from the optic nerve head. Her left eye’s best-corrected visual acuity (BCVA) was 20/50.

The patient was offered the opportunity to address her diagnosis, optic disc pit with serous macular detachment, via a combined surgical intervention. Surgeons recommended a pars plana vitrectomy (PPV) with an internal limiting membrane (ILM) peel. They bolstered this treatment with additional temporal peripapillary endolaser photocoagulation. 

At the patient’s 6-month postoperative follow up visit, her optic disc pit was still present, but the subretinal fluid had improved and her left eye’s BCVA was 20/40.

Although a single procedure may be appropriate for some cases, the combination of techniques used here resulted in improved fluid and BCVA.

“Although ODP with serous macular detachment is a well-known pathology, the origin of the fluid remains controversial,” according to the poster. 

In this patient’s case, surgeons prescribed brinzolamide twice daily to help reabsorb the subretinal fluid after surgery. However, due to pregnancy, the patient ceased the medication after 2 months.

Untreated, optic disc pit with serous macular detachment can lead to cystic changes, lamellar or full-thickness macular holes, and retinal pigment epithelial atrophy, the presentation warns.