32-year-old Turkish male patient presented with an optic disk pit and serous macular detachment in the left eye. Spectral domain optical coherence tomography revealed serous macular detachment and retinoschisis. After vitrectomy the retina gradually flattened and vision was gradually improved. We aimed to report a case of serous macula detachment secondary to optic pit and long term result of surgical treatment.
Optic disc pits are congenital disc abnormality secondary to a colobomatous malformation of the optic nerve head. Optic disc pit was first described by Wiethe in 1882 [
We present a case of optic disc pit associated with serous macular detachment which was successfully managed with vitrectomy. Such cases have been described in literature but long term results are rarely reported.
A 32-year-old Turkish male with no past history of note presented with central blurring of vision in his left eye for two months. His best-corrected visual acuity on the Snellen chart was 20/20 in the right eye and 20/200 in the left eye. The anterior segment examination was unremarkable and the intraocular pressure on Goldmann applanation tonometry was 17 mmHg on both eyes. A dilated fundus examination of the left eye revealed serous macular detachment (Figure
A 23-gauge pars plana vitrectomy with triamcinolone-assisted removal of posterior hyaloid interface was performed. After completing vitrectomy, internal limiting membrane peeling and fluid-air exchange were performed. Peripapillary endolaser barrage photocoagulation was performed temporally, and air-gas exchange was performed with perfluoropropane (C3F8) gas. The patient was instructed to keep prone for one week.
During the next six months the retina gradually flattened (Figure
Optic disc pit is an uncommon congenital anomaly, usually associated with macular serous retinal detachment [
The source of the subretinal fluid is controversial. It is postulated that the possible sources of intraretinal/subretinal fluid might be vitreous cavity [
Twenty-five percent of cases with maculopathy secondary to optic pit resolve spontaneously [
There is no consensus of the treatment of maculopathy secondary to optic pits. The treatment options range from barrage laser photocoagulation to vitrectomy, with or without adjunctive procedures such as internal limiting membrane (ILM) peel, gas tamponade, and laser photocoagulation. Shukla et al. performed vitrectomy with ILM peeling, barrage laser photocoagulation, and gas tamponade in their study [
Vitrectomy with or without internal limiting membrane peel, with or without gas tamponade, and with or without endolaser photocoagulation has also been reported to improve vision. Although there are several treatment options, none of them has been accepted as the best treatment method. Our treatment includes vitrectomy, posterior hyaloid and internal membrane peeling, gas tamponade, and laser photocoagulation. Some authors prefer surgical treatment without laser photocoagulation; for example, Hirakata et al. reported the success of vitrectomy with induction of posterior vitreous detachment and gas tamponade, without additional laser treatment in reattaching the macula, and improvement in central vision in most patients with optic disc pit maculopathy [
In conclusion, vitrectomy combined with posterior hyaloid and internal limiting membrane peel from the macular area, followed by air tamponade, with additional laser photocoagulation was successful for the treatment of optic disc pit maculopathy in our patient. Further studies are needed to explore the significance and impact of structural features in optic disc pit maculopathy on the choice of treatment and visual prognosis.
The authors declare that there is no conflict of interests regarding the publication of this paper.