Our patient had bilateral optic nerve colobomas with an optic pit in the left eye. Vision was 20/40 OD and 20/70 OS.
The serous fluid from the optic pit is in the superior macula with mild fluid in the subfoveal space, best noted on the macular OCT. Fluorescein angiography shows no leakage, indicating that this fluid is not exudative.
Our patient opted for no treatment due to minimal symptoms and fairly good vision.
Learning Points:
An optic nerve coloboma can be unilateral or bilateral and is caused by incomplete closure of the embryonic fissure.
While most optic pits are asymptomatic, they can cause vision loss by forcing fluid into the inner and outer retina and, ultimately, the subretinal space (optic pit maculopathy). The source of the fluid remains a point of ongoing debate, with the fluid originating either from the vitreous or the subarachnoid space.
A host of treatments for optic pit maculopathy have been suggested over the years. However, a recent meta-analysis suggested that a plain old vanilla vitrectomy without gas tamponade is as successful as any other procedure (Zheng et al Ophthalmology Retina 2020;4;289-299).
