Occult optic disc pit with macular schisis

Abstract

Sir, We would like to thank Dr Shukla for his comments related to our recent case report relating to a child with an outer retinal layer anomaly at the fovea.1 Shukla claims that we were incorrect to classify this as a full-thickness macula hole. We note that we did not claim that this was a full-thickness macular hole, and our case report highlights that the defect was only affecting the outer retinal layers,2 which when defined by Gass would fit with a stage I macula hole. However, we agree that we were incorrect to classify this curious outer retinal layer dehiscence with macula hole nomenclature, as on reflection we agree that this is more likely to be a case of an occult optic disc pit with macular schisis. We read with interest the case series of Shukla et al's relating to the optic disc pit,3 but regret that we were unaware of this article at the time of our initial case presentation, which was submitted for publication before Shukla et al's published case series. We are impressed that Shukla found this case of optic disc pit to be ‘open-and-shut'. Even on subsequent review of our images, we find that the optic disc is the same size as the fellow eye and this is atypical, as 79% of optic disc pits occur in discs that are larger than the fellow eye.4 Further, although the disc image (Figure 1) is suggestive of a probable disc pit temporally, the disc OCT (Figure 2) does not clearly demonstrate this. Figure 1 The right optic disc appears normal. The left optic disc is the same size, but despite this it appears to have a probable optic disc pit temporally. Figure 2 OCT of the left optic disc. In summary, we therefore agree with Shukla that this case is probably an optic disc pit associated with macular schisis, and we are glad that their management would have been similar and indeed the patient has done well post-operatively. We do, however, feel that this case is not that typical, and overall there remains more to be learnt about optic disc pits and macular schisis. Hopefully, more information will be obtained about optic disc pits from the planned UK prospective study in association with the British Ophthalmic Surveillance Unit.