Optic Disc Pit Maculopathy Management

Optic disc pit maculopathy (ODP-M) is a rare but sight-threatening complication of congenital optic disc pits, characterised by the accumulation of intraretinal and subretinal fluid at the macula. Management aims to restore macular anatomy, resolve fluid and optimise visual function. The principal modality is pars plana vitrectomy (PPV), often combined with induction of a posterior vitreous detachment to relieve vitreous traction. Adjunctive measures include insertion of an autologous scleral plug or glial tissue removal at the pit, inverted internal limiting membrane (ILM) flaps to seal the pit, laser photocoagulation at the temporal disc margin and gas tamponade to facilitate retinal reapposition. Surgical refinements have focused on minimising invasiveness, reducing long-term postoperative positioning and diminishing the need for prolonged tamponade. Multimodal imaging—particularly optical coherence tomography (OCT) and OCT angiography (OCTA)—is integral to staging disease severity, guiding timing of intervention and monitoring postoperative resolution of subretinal fluid, retinoschisis and choroidal remodelling. In some paediatric cases, spontaneous regression has been observed, but most adults require early surgical intervention to prevent irreversible photoreceptor damage. Despite variations in technique, most series report significant reduction in central macular thickness and gains in best-corrected visual acuity, with long-term stability in the majority of treated eyes.

Research from Nature Portfolio

A recent minimally invasive vitrectomy technique without ILM peeling or laser has demonstrated complete anatomical resolution in a small series. The procedure combined induction of posterior vitreous detachment with insertion of a scleral tissue plug into the optic pit and a short-acting gas tamponade. Patients experienced a sequential resolution of subretinal fluid, retinoschitic lesions and macular oedema over approximately 18 weeks, with full functional recovery and avoidance of prolonged head positioning. This approach underscores the potential of targeted pit occlusion to streamline surgery and enhance patient comfort while maintaining reliable anatomical and visual outcomes.

Research from all publishers

A multicentre study analysing subfoveal and peripapillary choroidal thickness reported significant postoperative thinning of the subfoveal choroid, suggesting choroidal remodelling after surgical repair. Eyes with early disease showed greater thickness reduction and better visual improvement than advanced cases, indicating that choroidal metrics may inform prognosis and timing of intervention. In parallel, an OCTA investigation of microvascular changes following 23-gauge PPV found preoperative reductions in capillary plexus density and choriocapillaris flow, with significant improvements at 12 months. Despite gains, vascular parameters did not fully normalise to fellow-eye levels, highlighting persistent microvascular compromise even after fluid resolution. These studies emphasise the importance of assessing both anatomical and vascular recovery in tailoring postoperative rehabilitation and exploring adjuvant therapies to support chorioretinal perfusion.

Optic Disc Pit Maculopathy Management publication trend

The graph below shows the total number of articles in optic disc pit maculopathy management across all publications each year (not limited to Nature Index journals).

Technical terms

Optic disc pit maculopathy: Accumulation of fluid in and under the macula secondary to a congenital excavation of the optic nerve head.

Pars plana vitrectomy (PPV): A microsurgical technique to remove vitreous gel via the pars plana to relieve traction and access the retina.

Internal limiting membrane (ILM): The innermost retinal layer; flaps or peeling can promote pit sealing and prevent fluid ingress.

Scleral plug: A small autologous scleral graft inserted into the optic pit to occlude the fluid pathway.

Gas tamponade: Intraocular injection of expansile gas to appose retinal layers and facilitate fluid resorption.

Optical coherence tomography angiography (OCTA): A non-invasive imaging modality that visualises retinal and choroidal microvasculature without dye.

Retinoschisis: Splitting of the retinal layers, often seen in association with subretinal fluid in ODP-M.

References

1. Minimally invasive procedure for optic disc pit maculopathy: vitrectomy with scleral plug and analysis on pattern of resolution. Scientific Reports (2023).
2. Choroid Involvement Secondary to Optic Disc Pit Maculopathy: OCT Analysis and Evolution After Surgical Treatment. American Journal of Ophthalmology (2024).
3. Changes in Outcomes of Macular Optical Coherence Tomography Angiography Following Surgery for Optic Disc Pit Maculopathy. Diagnostics (2024).
4. Optic disc pit maculopathy: when and how to treat? A review of the pathogenesis and treatment options. International Journal of Retina and Vitreous (2015).