Reversal of a glaucomatous optic disc pit

Congenital versus acquired optic disc pit maculopathy: An OCT based study

PURPOSE

The purpose of this study is to describe and compare the demographic, ocular, and imaging characteristics of a cohort of patients with congenital and acquired optic disc pit maculopathy (ODPM).

METHODS

This retrospective case series included patients diagnosed with ODPM between June 2017 and April 2023. These patients' baseline demographics, ocular characteristics, and optical coherence tomography (OCT) imaging characteristics and follow up changes were analyzed.

RESULTS

A total of 14 eyes with ODPM were identified (9 congenital and 5 acquired). Eyes with congenital ODP developed maculopathy at a younger age, presented commonly with visual symptoms, and exhibited an obvious pit at the temporal foveal margin as well as a high cup: disc ratio (p < 0.05). Primary open-angle glaucoma was identified in all five eyes with acquired ODPM. On OCT, eyes with acquired ODPM lacked the characteristic nerve fibre layer schisis, outer retinal layer hole, and foveal serous macular detachment (p < 0.05) unlike congenital ODPM. At the final follow-up visit, two cases from the congenital ODPM group and one case from the acquired ODPM group displayed complete resolution of maculopathy. The two cases of congenital ODPM were treated with pars plana vitrectomy and laser barrage to the optic disc margin, while the solitary case of acquired ODPM was treated with trabeculectomy surgery alone.

CONCLUSION

Clinical examination and baseline OCT imaging reveal distinct differences between congenital and acquired ODPM eyes. These characteristics may help with accurate diagnosis and treatment planning for these two distinct clinical entities.

Successful resolution of serous macular detachment following glaucoma-filtering surgery alone for acquired optic disc pit maculopathy

PURPOSE

To describe a case of acquired glaucomatous optic disc pit-related maculopathy successfully treated with glaucoma filtering surgery alone.

CASE DESCRIPTION

A 67-year-old male was diagnosed with advanced primary open angle glaucoma in both eyes, with a cup: disc ratio of 0.85 in the right eye and 0.95 in the left eye. Visual acuity at presentation was 20/60, and intraocular pressure was 14 mm Hg in the left eye. The fundus of the left eye revealed a serous macular retinal detachment due to an acquired optic disc pit.

RESULTS

The left eye of the patient underwent combined cataract and glaucoma filtering surgery. The serous macular detachment resolved completely 15 months after surgery, with a documented visual acuity of 20/40 and intraocular pressure of 10 mm Hg without the use of additional antiglaucoma medications. There was no recurrence of serous macular detachment even after the two-year follow-up visit.

CONCLUSION

This case demonstrates that controlling intraocular pressure alone resulted in complete resolution of serous macular detachment in acquired optic disc pit maculopathy without the need for pars plana vitrectomy.