Three Dimension Spectral Domain Optical Coherence Tomography: an Important Tool for Diagnosis, Treatment and Follow-up of Optic Disc Pit in Elderly Patients

Abstract

Purpose : Our purpose was to study the clinical manifestations and course of optic pit maculopathy using Spectral Domain Optical Coherence Tomography (SD- OCT) in elderly patients who were misdiagnosed for this condition.
The origin of the fluid and precise pathophysiology of optic disc pit maculopathy remains unclear. It has been suggested that submacular fluid originates either from vitreous or cerebrospinal fluid. We report a case series of optic disc pit maculopathy which were unsuccessfully diagnosed without using SD OCT. Using this technique we achieved to distinguish this pathology, treat it and follow its evolution.

Methods : We examined 35 eyes of 32 patients with macular detachment combined with optic disc pit. All patients were 65 years old or older.
They were mistreated as neovascular membrane due to age-related maculopathy.
The diagnosis and monitoring of patients were done by means of: symptoms, Fluorescein Angiography, SD-OCT and Best Corrected Visual Acuity (BCVA) with ETDRS charts. Patients visual acuity prior to surgery was in average 20/300.

Results : We observed six different foveal appearances in regard to fluid localization. We could clearly distinguish optic disc pit and neovascular membrane using this technology. Fluid accumulation was observed below the margin of the optic disc and hyperreflective porous tissue was onserved in the optic disc excavation. We were able to diagnose optic disc pit faster and better.

Conclusions : Considering that this OCT technique has no relevant side effects, we strongly recommend using it in every patient who has any kind of maculopahty, since optic disc pit could be a probable differential diagnosis.
3-dimensional SD-OCT scans revealed a connection between subretinal space, intraretinal space, perineural space, and the vitreous cavity. Therefore, we suggest that intraretinal or subretinal fluid in optic disc pit maculopathy may have both a vitreous and cerebrospinal origin, as it has been published.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.