OPTICAL COHERENCE TOMOGRAPHY OF MACULAR LESIONS ASSOCIATED WITH OPTIC-NERVE HEAD PITS

Purpose: Although optic pits were described more than a century ago, t he pathogenesis and pathologic nature of the associated macular lesion s remain controversial. The authors used the technique of optical cohe rence tomography (OCT) to further define the anatomic relation that ex ists between optic pits, macular schisis-like spaces, and macular deta chments. Methods: Four eyes of three consecutive patients with optic p it-related macular pathology were evaluated. Cross-sectional OCT image s were correlated with findings from slit-lamp biomicroscopy and stere o fundus photography. All eyes previously had undergone unsuccessful p hotocoagulation to the temporal juxtapapillary retina. One eye had und ergone vitrectomy and intraocular gas tamponade, resulting in partial resorption and displacement of the submacular fluid. Results: Retinal edema and cystic degeneration were present, overlying macular neurosen sory detachments in all four eyes. The most prominent edema was presen t in the outer retina at the level of the outer plexiform layer. This mimicked a true retinoschisis cavity, although bridging retinal elemen ts were identifiable. A lesser degree of edema was present in the inne r retina, predominantly located between the disc and fovea. In one eye , a lamellar hole was shown to be a defect in the outer neurosensory r etina. In another eye, a macular detachment developed under a pre-exis ting schisis-like cavity. The schisis-like cavity or edematous retina communicated with the optic disc in all eyes, whereas none of the eyes demonstrated a direct connection between the macular detachment and o ptic pit. Conclusion: These findings support the concept of a bilamina r structure in which a macular detachment develops secondarily to a pr e-existing schisis-like lesion consisting of severe outer retinal edem a. Fluid may enter from the optic pit into the retinal stroma and not directly into the subretinal space, explaining the prolonged recovery and frequency of treatment failure after photocoagulation to the juxta papillary retina.