Optic pit associated serous macular detachment

Abstract

We read with interest the article by Beer et al. [1] on the management of serous macular detachment with vitreoretinal surgery. The authors have elucidated the management of a rare and often difficult disease and must be congratulated for the same. We wish to clarify a few issues that appear relevant in the management of this disease. Contrary to earlier thought, the ‘‘macular detachment’’ associated with optic pit has been found to be essentially a retinoschisis, the retinal detachment being secondary to it. Optical coherence tomography (OCT) must be employed to study the macular anatomy of such patients with optic pit and retinoschisis and this appears to have been overlooked by the authors [2]. If the OCT reveals a predominantly schitic cavity with minimal subretinal fluid, a full thickness retinotomy, as performed by the authors will result in drainage of only minimal quantities of subretinal fluid. The fluid within the schisis cavity being viscous, would not pass easily through the outer layer break of the schisis into the subretinal space, to be drained through a full thickness retinotomy. We have attempted drainage of the subretinal fluid through the pit; this seldom flattens the retina but in selected cases, if the subretinal fluid is not viscous a minimal amount of fluid can be drained out and this will at least avoid an iatrogenic retinotomy in the macular region and its attendant complications. Based on the authors experience, it appears prudent not to drain the subretinal fluid associated with optic disc pit, at least not through a drainage retinotomy. Vitreous traction over the posterior pole and the presence of a defect at the optic pit area contribute to the pathogenesis of the schisis/ detachment associated with optic disc pit. Hence, it is essential to identify and detach the posterior hyaloid for success of the surgery and would have reemphasized the importance of this step, had the authors mentioned it in their manuscript. Successful collapse of the schisis/detachment has been achieved simply by excising the vitreous, inducing the posterior vitreous detachment and gas tamponade without laser photocoagulation [3, 4]. However, laser photocoagulation may ensure long-term success of the surgery. It would also be interesting to know if the authors used any particular wavelength of laser energy to treat the peripapillary area. A red/ infra-red wavelength may offer the advantage of deeper penetration and less transmitted thermal P. M. Shanmugam (&) AE D. S. C. Lam Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong e-mail: shanmugam1998@yahoo.com