Wall of Fame

Optic Nerve Pit

3/23: Congratulations to Emma Oreskovic and Natasha Draca for submitting the Retina Rocks Case of the Month. This 14YO boy presented with these asymptomatic and unilateral findings in his left eye. Vision was 20/50. Fundus imaging (top) shows a large vertical oval of retinal elevation extending from the superior macula into the inferior midperiphery (yellow arrows). This fluid connects to an inferotemporal optic nerve pit (blue arrow). OCT scanning (bottom) shows subretinal fluid (red arrow), cystic fluid mostly in the outer nuclear layer (orange arrow), and fluid below the internal limiting membrane vs within a split nerve fiber layer (pink arrow). He was referred to a retinal specialist for further evaluation and possible treatment. An optic nerve pit is a rare (about 0.1% prevalence) congenital anomaly thought to be caused by incomplete closure of the optic fissure during gestation. Pits are most commonly located within or along the inferior-temporal disc margin and usually appear as a gray depression. While most optic pits are asymptomatic (as in this case), they can cause vision loss due to fluid being forced into the inner retina, outer retina, and finally the subretinal space (optic pit maculopathy). The source of the fluid continues to be a source of ongoing debate, coming from either the vitreous or 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).