13.4  Optic Disc Pit Retinal Detachment and Maculopathy

Management of optic disc pit retinal detachment is controversial. There is often a combination of sub-retinal and intra-retinal fluid (the latter often incorrectly being termed retinoschisis[1]). Debate remains as to whether the fluid originates from the subarachnoid space (cerebrospinal fluid) around the optic nerve, or from the vitreous cavity (Figure 13.4.1).[2] Regardless, the management is likely to be the same. While there is a 25% chance of spontaneous resolution, long standing (longer than 3 months) neuro-sensory detachment of the fovea generally results in poor visual outcomes (Figure 13.4.2).[3] Non-surgical approaches include: laser demarcation of the optic pit at the temporal margin of the optic nerve and intravitreal gas injection. A surgical approach should be considered in cases where neurosensory detachment is affecting or threatening the fovea, as well as progressive and symptomatic cases. Due to the rare nature of this entity the evidence in the literature is based on small scale series alone. Surgical interventions that have been described include:

Imamura Y, Zweifel SA, Fujiwara T, Freund KB, Spaide RF. High-resolution optical coherence tomography findings in optic pit maculopathy. Retina. 2010 Jul-Aug;30(7):1104-12. Accessed July 28, 2019.

Georgalas I, Ladas I, Georgopoulos G, Petrou P. Optic disc pit: A review. Graefe’s Arch Clin Exp Ophthalmol. 2011. doi:10.1007/s00417-011-1698-5

  1. Maximal relief of vitro-retinal traction: Pars plana vitrectomy and induction of posterior vitreous detachment (PVD), removal of any glial tissue or vitreous plugging the optic disc pit and peeling of any epiretinal membrane and internal limiting membrane around the optic nerve.[3] Since these patients can be young to middle-aged, one can expect strong vitreo-retinal adhesion.
  2. Inner retinal fenestration: After core vitrectomy (with or without PVD induction), a bent 25-gauge needle is used to make a partial retinal thickness retinotomy just temporal to the optic disc pit.[4] The aim is to allow a conduit for fluid to exit from underneath and within the retina to the vitreous cavity, regardless of the source of the fluid (Figure 13.4.3).
  3. Macular buckle[5]

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