Associated Retinal Changes
Optic pits have been associated with serous retinal detachments in up to as many as 50% of all cases. These detachments may occur at any age but most frequently present in early adulthood. The most popular theory behind this association is a separation of the layers of the retina, known as retinoschisis, due to fluid (the vitreous humour) entering the optic pit and traveling between the inner and outer layers of the retina. The outer layer may then subsequently detach. Evidence of retinoschisis has been demonstrated using OCT (see Figure 3).
Centrally located optic pits are less likely to cause changes in the retina. However, if located more peripherally in the optic disc, then it is more likely to cause a serous retinal detachment. Furthermore, if the optic pit is located temporally (which the majority are), then it is more likely to cause detachment of the macula because of the macula's proximity to the temporal side of the optic disc. If serous macular detachment occurs, a patient’s visual acuity may become as poor as 20/200 or worse.
Treatment for optic pit-associated macular detachment involves photocoagulation of the retina by use of an ion laser (either krypton or argon). This procedure works by burning one or more rows in between the optic disc and areas of serous retinal detachment. In most cases, macular reattachment results and visual acuity can be restored to about 20/80. This procedure may also be utilized prior to macular detachment in order to help prevent the future development of macular detachment. Other treatments for optic pit-associated macular detachment include macular buckling, gas tamponade, or vitrectomy. Some experts feel that the best results can be attained when the use of any of the above mentioned modalities (laser photocoagulation, macular buckling, gas tamponade, and vitrectomy) are used in combination.
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