Optic Disc Pit Maculopathy: Review of Recent Advances in Its Diagnosis and Management

Abstract

Optic disc pit (ODP) is a rare congenital anomaly of the optic disc which is usually unilateral and sporadic. It can lead to visual impairment secondary to ODP maculopathy characterised by intraretinal and subretinal fluid collection at macula with no known trigger factors. We came across a case of ODP maculopathy being misdiagnosed and mistreated as chronic CSR which led us to review the advances in its diagnosis and management as ODP maculopathy left untreated carries poor prognosis. Its management remains challenging as there are no clear guidelines and multiple modalities are available. Although few cases of spontaneous resolution of maculopathy are reported in literature but current management of ODP maculopathy is surgical intervention. The most commonly performed surgery for ODP maculopathy is 23 G PPV, either alone or in combination with ILM peeling, gas tamponade or laser photocoagulation. Recent treatment modalities available are intravitreal gas tamponade, macular buckling, inner retinal fenestration, glial tissue removal and autologous fibrin. Prognosis is poor if multilayer intraretinal and subretinal fluid collection is seen on OCT while cases where fluid don’t reach to macular arcade vessels have better anatomical and visual outcomes. Even though there are many recent advances in the diagnosis and management of disease, management remains challenging as there are no comparative studies of different therapeutic modalities and their success rate, related to the anatomical and functional outcomes. This review discusses the literature on possible pathogenesis of ODP maculopathy as well as the recent advances in its diagnosis and management.