OPTIC PITLIKE MACULOPATHY WITH CLINICALLY OCCULT OPTIC DISK PIT DIAGNOSTIC IMAGING, CLINICAL FEATURES, AND MANAGEMENT.

Abstract

To describe the diagnostic imaging, clinical features, and management of pitlike maculopathy and clinically occult optic pit (OOPM). The demographics, imaging features, and intervention details of the subjects with OOPM enrolled from 19 sites were retrospectively analyzed. The main outcome measure was the detection of an occult pit in OOPM. Forty-seven eyes (46 subjects) with pitlike maculopathy without a visible optic pit were studied. Maculopathy consisted of multilayered retinoschisis and/or serous detachment (44 eyes); 3 eyes showed nonglaucomatous nerve fiber layer defects. Optical coherence tomography revealed a craterlike disk cavitation in 40 eyes (85%). Infrared imaging and fluorescein angiography, when performed, revealed the occult pit in 5 of 18 (29%) and 3 of 13 (23%) eyes, respectively. Clinical clues to an occult pit included anomalous or enlarged optic nerve head and cilioretinal artery (36%, 33%, and 32% eyes, respectively). Twelve eyes (26%) had coexistent glaucoma. Follow-up was available for 35 eyes (75%): 22 were observed, 11 underwent vitrectomy, and 2 had gas injection. Intervention reduced macular fluid in 85% eyes and improved best-corrected visual acuity (P = 0.012). Optical coherence tomography revealed a cavitation attributable to the optic pit in most eyes with pitlike maculopathy, helped by clinical clues such as anomalous/enlarged disk and cilioretinal artery. The surgical intervention was infrequent but successful.