Spectral domain optical coherence tomography imaging in optic disk pit associated with outer retinal dehiscence

Abstract

A 37-year-old Bangladeshi male presented with an inferotemporal optic disk pit and serous macular detachment in the left eye. Imaging with spectral domain optical coherence tomography (OCT) revealed a multilayer macular schisis pattern with a small subfoveal outer retinal dehiscence. This case illustrates a rare phenotype of optic disk maculopathy with macular schisis and a small outer retinal layer dehiscence. Spectral domain OCT was a useful adjunct in delineating the retinal layers in optic disk pit maculopathy, and revealed a small area of outer retinal layer dehiscence that could only have been detected on high-resolution OCT.

Fissure, fluid, and functional loss

“…[ 1 2 ] Visual deterioration is either due to associated macular changes or to the development of maculopathy. [ 1 2 3 4 5 ] Histologically, optic disc pit represents a defect in the lamina cribrosa. [ 1 2 3 4 5 6 ]…”

“…Optic pits along the rim of the optic disc are most likely to lead to serous detachments of the retina, with associated full-thickness or laminar retinal holes, retinal pigment epithelium mottling, and general cystic changes. [ 2 3 ] The retinal detachments usually confined between the superior and inferior vascular arcades, are contiguous with the optic disc and have cystic and schisis-like spaces involving the inner retinal layers, while the outer retina may secondarily detach as fluid accumulates in the subretinal space. [ 2 3 4 ]…”

“…Four hypothesis predominate, each with varying levels of supporting evidence: Posterior vitreous abnormalities like vitreomacular or vitreopapillary traction, cerebrospinal fluid leaks from the subarachnoid space; fluid conduction through Bruch's membrane and the retinal pigment epithelium, and leak from immature or unsupported vessels within the optic disc pit. [ 1 2 3 4 5 ]…”

“…Ancillary tests like visual field charting, optical coherence tomogram, fundus fluorescein angiogram aid in confirming the diagnosis. [ 1 2 3 4 5 ]…”

“…Anomalies on the optic nerve head like – remnants of internal limiting membrane (inner limiting membrane of Elsching), connections between subretinal, and intraretinal space, perineural space, and the vitreous cavity, fluid spaces within the optic disc, may also be delineated. [ 2 3 ]…”