SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY IMAGING OF THE OPTIC PIT COMPLEX.

Purpose

To reassess the anatomical basis of optic disc pit maculopathy using swept source optical coherence tomography and to characterize the broader structural abnormalities comprising the optic pit complex.

Methods

Sixteen patients with optic disc pit maculopathy were imaged using a high-resolution swept source optical coherence tomography system (DREAM optical coherence tomography). Cross-sectional and volume-rendered scans were analyzed for lamina cribrosa defects, intraneural cavitations, and pathways for fluid entry into or beneath the retina.

Results

All eyes demonstrated lamina cribrosa defects with associated cavitations extending a mean of 1855 ± 492 µ m posterior to a modified Bruch membrane opening. Four distinct patterns by which fluid entered the retina were observed: (1) direct channels from cavitations into the retina, (2) perivascular hyporeflective spaces, (3) intraneural channels extending toward cystoid spaces, and (4) isolated retinal cysts without a visible interconnection. Vitreous remnants, trabecular structures, or disorganized connective tissue were found within the optic nerve pit in several eyes. In 13% of cases, the pit was not visible by ophthalmoscopy due to overlying tissue. These structural variations frequently coexisted, and associated abnormalities extended beyond the optic disc margins.

Conclusion

Optic disc pit maculopathy is associated with a spectrum of deep optic nerve abnormalities, collectively termed the optic pit complex. The combination of laminar disruption, cavitations, and multiple anatomical conduits for fluid ingress broadens the morphologic understanding of this condition. Swept source optical coherence tomography enables visualization of structures not accessible by ophthalmoscopy and may improve diagnostic precision, guide treatment decisions, and clarify the diverse mechanisms contributing to fluid accumulation in optic disc pit maculopathy.