Spontaneous Resolution ofLong-Standing Macular Detachment due to Optic Disc Pit with Significant Visual Improvement

Abstract

Purpose: To report a case of spontaneous resolution of a long-standing serous macular detachment associated with an optic disc pit, leading to significant visual improvement. Case Presentation: A 63-year-old female presented with a 6-month history of blurred vision and micropsia in her left eye. Her best-corrected visual acuity was 6/24 in the left eye, and fundoscopy revealed serous macular detachment associated with optic disc pit, which was confirmed by optical coherence tomography (OCT). The patient was offered vitrectomy as a treatment alternative, but she preferred to be reviewed conservatively. Three years after initial presentation, neither macular detachment nor subretinal fluid was evident in OCT, while the inner segment/outer segment (IS/OS) junction line was intact. Her visual acuity was improved from 6/24 to 6/12 in her left eye, remaining stable at the 6-month follow-up after resolution. Conclusion: We present a case of spontaneous resolution of a long-standing macular detachment associated with an optic disc pit with significant visual improvement, postulating that the integrity of the IS/OS junction line may be a prognostic factor for final visual acuity and suggesting OCT as an indicator of visual prognosis and the probable necessity of a surgical management.

Optic disc pit maculopathy: when and how to treat? A review of the pathogenesis and treatment options

“…Although spontaneous resolution is possible in as many as 25% of cases and visual improvement is possible [14, 15, 93], observation will generally lead to significant visual loss [16–18]. Initially it has been recommended to wait for spontaneous resolution for up to 3 months before considering surgery [4, 33], but today currently observation is deemed unjustified [10, 80].…”

Unusual coexistence of bilateral optic disc pits with unilateral macular hole

“…3 As far as the right eye is concerned, we advised prophylactic surgery, however he refused it too and so we had to adopt a conservative approach involving a regular follow up as has been advocated by some authors too. 10 …”

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 ]…”

“…[ 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 ]…”