Imaging congenital optic disc pits and associated maculopathy using optical coherence tomography

Objective: To elucidate the anatomy of congenital optic disc pits with and without maculopathy using optical coherence tomography. Setting: All patients were examined, photographed, and scanned at the New York Eye and Ear Infirmary. Patients: Ten eyes of eight consecutive patients with congenital optic disc pits were studied. Three eyes had associated serous macular detachment (group 1), four had evidence of resolved detachment (group 2), and three had no clinical macular pathologic lesion; (group 3). Methods: Optical coherence tomography, a new, noninvasive, noncontact, imaging technology capable of producing cross-sectional images of the retina in vivo with high resolution (<17 mu m) was used to obtain multiple cross-sectional images of the pit, peripapillary retina, and macula. Ophthalmologic examination and standard fundus photography were performed on all eyes. Fluorescein angiography was performed in eyes that had associated macular detachment. Results: Communication between a schisis cavity or subretinal space and the optic nerve pit was imaged in all eyes in group 1. No such communication could be identified in groups 2 and 3. Cystic degeneration and schisis were imaged in the peripapillary retina, macula, or both in all eyes of groups 1 and 2 and in one patient in group 3. A direct communication between the subretinal space and vitreous cavity could not be identified in any eye. Conclusions: Schisis formation plays an integral role in the development of serous retinal detachment in the presence of congenital optic disc pits. Our findings are consistent with the theory that the optic disc pit acts as a conduit for fluid flow between the schisis cavity or subretinal space and the subarachnoid space.