Intraoperative OCT Findings During Surgery for Optic Disc Pit–Associated Maculopathy

Optic disc pit (ODP) is an extremely rare congenital anomaly secondary to colobomatous malformation of the optic nerve head. The pathogenesis, nature, and source of the fluid in ODP-associated maculopathy remain unclear and it is unknown whether the fluid is liquefied vitreous through a sieve-like connection or cerebrospinal fluid (CSF) through a channel in the peripapillary subarachnoid space. In this report, we describe the real-time anatomical evaluation of the optic pit using a continuous intraoperative OCT-enabled microscope system during the surgical treatment of a rare case of ODP-associated maculopathy in an 8-year-old girl. Contrary to a previous report, extensive aspiration just over the optic pit did not result in subretinal fluid drainage, as revealed by OCT, suggesting no definite connection between the vitreous cavity and the subretinal space. Both preoperative and intraoperative imaging strongly suggest CSF as the primary fluid source.