2020–2021 BCSC Basic and Clinical Science Course™
12 Retina and Vitreous
Part II: Disorders of the Retina and Vitreous
Chapter 16: Retinal Detachment and Predisposing Lesions
Macular Lesions Associated With Retinal Detachment
Optic Pit Maculopathy
Optic pits are small, hypopigmented, yellow or whitish, oval or round, excavated colobomatous defects of the optic nerve; they are usually found within the inferior temporal portion of the optic nerve head margin (Fig 16-19). Most are unilateral, asymptomatic, and congenital, but they can be acquired in the setting of glaucomatous excavation. Optic pits may lead to serous macular detachments with a poor prognosis if left untreated. The macular retinal thickening and detachment typically extend from the optic pit in an oval shape toward the fovea. OCT imaging reveals macular schisis as well as subretinal fluid. Whether the subretinal fluid is liquid vitreous or cerebrospinal fluid is controversial; a proteomic analysis of fluid in 1 adult case confirmed that vitreous was the definite source. Optic pits are among the few conditions associated with macular schisis. Various successful treatments have been reported, involving vitrectomy with gas-bubble placement.
The differential diagnosis of optic pits includes glaucomatous nerve damage, such as optic pit–like changes that may occur at the inferior or superior pole of the optic nerve. Optic pits are also included in the differential diagnosis of macular thickening or detachment. Careful examination of the optic nerve margin is important for recognizing this condition.
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Bottoni F, Cereda M, Secondi R, Bochicchio S, Staurenghi G. Vitrectomy for optic disc pit maculopathy: a long-term follow-up study [epub ahead of print February 6, 2018]. Graefes Arch Clin Exp Ophthalmol. doi: 10.1007/s00417-018-3925-9.
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Jain N, Johnson MW. Pathogenesis and treatment of maculopathy associated with cavitary optic disc anomalies. Am J Ophthalmol. 2014;158(3):423–435.
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Ooto S, Mittra RA, Ridley ME, Spaide RF. Vitrectomy with inner retinal fenestration for optic disc pit maculopathy. Ophthalmology. 2014; 121(9):1727–1733.
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Patel S, Ling J, Kim SJ, Schey KL, Rose K, Kuchtey RW. Proteomic analysis of macular fluid associated with advanced glaucomatous excavation. JAMA Ophthalmol. 2016;134(1):108–110.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.