Spontaneous Resolution of Long-Standing Macular Detachment due to Optic Disc Pit with Significant Visual Improvement
A 63-year-old female presented at the outpatients department complaining about blurred vision and micropsia in her left eye for 6 months. She had no other symptoms, no previous ocular history and her general health was unremarkable. On examination, her best-corrected visual acuity was 6/7.5 in the right eye and 6/24 in the left eye. Slit-lamp examination revealed immature cataract in both eyes (+1 nuclear sclerosis), and both anterior segments were normal. Intraocular pressure was normal in both eyes as well. Dilated fundoscopy revealed normal fundus in the right eye and a serous elevation of the macular region in the left eye, for which the patient was referred to the medical retina department for further investigation.\nA more detailed fundus examination of the left eye revealed a large optic nerve head and a grey pit at the inferotemporal margin of the optic disc in association with serous macular detachment. Optical coherence tomography (OCT) confirmed the diagnosis of macular schisis communicating nasally with an optic disc pit, showing a hyporeflective area corresponding to the edge of the pit where there was communication with the schisis cavity (fig. ). Fluorescein angiography (FA) and an indocyanine green angiogram excluded other causes of serous retinal pigment epithelium detachment, showing pooling in the area of serous macular detachment and no leakage from the pit even at the late stage (fig. ). Additionally, MRI was performed to rule out any other abnormalities related to optic disc pit, but it was totally clear.\nThe patient was offered vitrectomy as a treatment alternative, but taking into account the potential risks and benefits of the surgery, she declined and was reviewed routinely on a 4-monthly basis. Interestingly enough, 3 years after initial presentation, neither macular schisis nor subretinal fluid were evident on OCT (fig. ), and her visual acuity was significantly improved from 6/24 to 6/12 in the left eye, which remained stable at the 6-month follow-up after resolution of macular detachment.