13.4  Optic Disc Pit Retinal Detachment and Maculopathy

Management of optic disc pit retinal detachment is controversial. There is often a combination of sub-retinal and intra-retinal fluid (the latter often incorrectly being termed retinoschisis[1]). Debate remains as to whether the fluid originates from the subarachnoid space (cerebrospinal fluid) around the optic nerve, or from the vitreous cavity (Figure 13.4.1).[2] Regardless, the management is likely to be the same. While there is a 25% chance of spontaneous resolution, long standing (longer than 3 months) neuro-sensory detachment of the fovea generally results in poor visual outcomes (Figure 13.4.2).[3] Non-surgical approaches include: laser demarcation of the optic pit at the temporal margin of the optic nerve and intravitreal gas injection. A surgical approach should be considered in cases where neurosensory detachment is affecting or threatening the fovea, as well as progressive and symptomatic cases. Due to the rare nature of this entity the evidence in the literature is based on small scale series alone. Surgical interventions that have been described include: