POSTTRAUMATIC MACULAR BREAK ASSOCIATED TO CONGENITAL OPTIC DISC PIT AND PREEXISTING SENSORY MACULAR DETACHMENT

Background. Optic disc pits represent a rare congenital abnormality fr equently associated with macular detachment. Several theories on the p athogenesis of the detachment have been proposed, but the issue still remains unclear. Treatment remains speculative as well; advocated trea tments include eye-patching, bed rest, steroids, laser photocoagulatio n, pars plana vitrectomy with fluid-air exchange and optic nerve sheat h decompression. Methods. The Authors report on the case of an optic p it with associated macular detachment which developed an inner layer m acular hole and, after an apparently insignificant skull trauma, a lar ge macular break. The patient underwent a standard three-port pars pla na vitrectomy, fluid gas-exchange, posterior scleral buckling and lase r treatment. Results, Twelve months after surgery the retina was flat, posterior buckling was evident and laser treatment pigmented. Visual acuity was 20/600. Conclusions. The presence of strands of condensed v itreous strands crossing the posterior lacuna and exerting traction ov er the macula and optic disc, support the theory of a possible tractio nal role of anomalous vitreous adhesion in the pathogenesis of the det achment and macular break. Anomalous vitreous adhesion over the poster ior retina could be related to the malformative genesis of the syndrom e, and the anomalous persistence of the Cloquet's canal or primary vit reous could be responsible for the traction.