Optic Pit

Fig. 51.1 Optic pit and related serous detachment of the macula. The pit, visible as small whitishgrayish area just temporal to the emergence of the blood vessels on the disc, caused a long-standing macular detachment. The border

of the detached is clearly delineated; the chronicity of the condition is shown by the secondary pigmentary changes around the fovea and the presence

of subretinal precipitates

Fig. 51.2 OCT image of the macular changes in an eye with optic pit. There is subretinal and intraretinal fluid. Obviously, the condition is not a true retinoschisis, simply large areas of (confluent) cystic retina

51.2Surgical Technique

•Perform a subtotal PPV with the creation of a PVD.

–PVD is not easy in these eyes4 but must carefully be completed nevertheless.

•Perform laser treatment at the disc margin (see Fig. 51.3).

–The goal of the laser treatment is to “close the gate” and prevent the fluid to be channeled from the pit cavity into the suband intraretinal spaces. Without proper laser walling-off, the recurrence rate is much higher.

4 The widespread, strong posterior vitreoretinal adhesion tempted several surgeons to suggest a role for VR traction in the pathogenesis. It is more likely, though, that the phenomenon is explained by the young age of the patients; traction in other diseases very rarely leads to the accumulation of subretinal fluid.

Fig. 51.3 Laser treatment for an optic pit-related macular detachment. The treatment should consist of confluent spots, at least two rows, and carried beyond the vertical line bisecting the disc between 6 o’clock and 12 o’clock (between 11 and 7 o’clock in this picture). If a smaller area is treated (only a semicircle), the fluid may find its way around it and cause a recurrence

–In eyes with a long history of subretinal fluid (many months, even years), the fluid is very thick and will not absorb for months; the laser treatment will thus be ineffective. In these eyes it is necessary to create a small retinotomy inferotemporally to the fovea in the macular area and actively aspirate the fluid.

–The laser spots should not be very strong; the nerve fibers are thus spared and the only consequence to the patient is an enlarged blind spot.

•Gas tamponade should be considered to help push the subretinal fluid inferiorly (see Fig. 51.4), out of the visual center and out of the area adjacent to the temporal disc margin (see Sect. 30.3.1).

Fig. 51.4 Postoperative appearance of an optic pit-related detachment with residual subretinal fluid. The gas bubble (not visible anymore) has successfully pushed the fluid out of the maculopapillary bundle, but the fluid still persists inferiorly. If the submacular fluid recurs, the surgeon knows that the initial surgery should have included drainage of the subretinal fluid through a small retinotomy