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Spontaneous resolution of serous macular detachment and outer retinal defect in optic disc pit maculopathy

Optic disc pit (ODP) is a rare congenital optic disc abnormality, with grey-white, oval depressions usually located at the temporal part of the optic disc. ODP creates an anomalous communication between the intraocular and extraocular spaces. ODP maculopathy (ODP-M) describes macular changes that occur in the context of an ODP, which include intraretinal and subretinal fluid accumulation, and retinal pigment changes, which may result in irreversible central visual field defects and reduced central visual acuity. ODP-M occurs in 25–75 per cent of patients with a temporal ODP. There is no known trigger for the development of ODP-M. Since ODPM usually occurs and becomes symptomatic in the third and fourth decades of life, it has been postulated to be associated with posterior vitreous detachment. However, ODPM has also been reported in paediatric patients with no posterior vitreous detachment and no vitreous liquefaction. There are no prophylactic treatments for ODP-M, and prophylactic peripapillary laser is not recommended as it has not been studied as a preventative measure, and may be associated with the creation of significant visual field defects in asymptomatic eyes. Twenty-five per cent of ODP-Ms resolve spontaneously, but the final outcomes are shown to be poor since the majority of cases have had a poor prognosis, with a natural history of gradual worsening, and a final visual acuity of 6/60 or worse. Therefore, different treatments such as vitreoretinal surgery have been suggested to be preferable over observation as they may prevent irreversible vision loss. However, there are no established guidelines for the treatment of ODP-M, and there is no consensus on the mechanism of pathogenesis or the optimal surgical technique, most of which are challenging to perform.