The role of cerebrospinal fluid in optic disc pit maculopathy: a case report studied by enhanced depth imaging optical coherence tomography (EDI‐OCT)

Abstract

AbstractPurpose Optic disc pit(ODP) is a rare congenital optic disc abnormality characterized by a localized grayish‐white depression usually in the center or inferotemporal part of the optic nerve head. It is generally unilateral (85‐90%) and its prevalence is estimated to be 1 in 11,000. Unless the ODP develops maculopathy, patients remain asymptomatic. Serous macular detachment may occur in up to 50% of cases, leading to significant decrease in visual acuity. Although the pathogenesis of ODP maculopathy is unclear, various theories about its onset have implicated fluid entry either from the vitreous cavity or from leakage of cerebrospinal fluid through the peripapillary subarachnoid space. The aim of this study was to evaluate the source of subretinal fluid under the macula in a patient with ODPMethods Enhanced depth imaging optical coherence tomography(EDI‐OCT) using the stars scan pattern of the Spectralis HRA + OCT (version 1.5.12.0; Heidelberg Engineering) was usedResults Horizontal SD‐OCT section revealed a small amount of intraretinal fluid in the outer nuclear layer and a prominent serous macular detachment at the same time but with no relationship with either the vitreous cavity or the subarachnoid space. However, a direct communication between the subretinal space and the peripapillary subarachnoid space through the ODP was demonstrated for the first time by using EDI‐OCT.Conclusion This case supports the theory that the source of serous macular detachment in some ODP cases could be cerebrospinal fluid passing into the retina through the ODP due to an incomplete closure of the embryonic fissure