From the Vitreous–Retina–Macula Consultants of New York, and the LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York.
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Serous macular detachment eventually occurs in 40% to 50% of patients with optic nerve pits.1 Although serous macular detachment is the most common sequela leading to vision loss in these patients, the origin of the fluid remains to be elucidated. Various theories have implicated fluid entry either from the vitreous cavity or from cerebrospinal fluid via the peripapillary subarachnoid space.2,3 In any case, the subretinal fluid causes a disruption of the normal retinal anatomy resulting in a lack of apposition between photoreceptor outer segments and retinal pigment epithelium (RPE). Interestingly, patients with serous detachment of the macula secondary to an optic nerve pit develop yellow subretinal flecks. Fundus autofluorescence photography in conjunction with optical coherence tomography has become essential in evaluating the photoreceptor–RPE complex. Autofluorescence photography can be used to monitor levels of fluorophore accretion in the subretinal space and RPE. We report the autofluorescence photography findings for three patients with subretinal fluid from optic pit maculopathy.Case ReportsCase 1A 44-year-old man presented with a gradual decline in vision and metamorphopsia in the right eye for the past 5 months. Best-corrected visual acuity was 20/30 in the right eye and 20/20 in the left eye. There was an inferotemporal optic pit associated with a serous retinal detachment. Admixed within the subretinal fluid were scattered yellowish subretinal precipitates more numerous than at initial presentation (Fig. 1A). OCT demonstrated a schisis cavity of the inner and outer layers of the retina located at the margin of the optic pit along with a shallow temporal neurosensory detachment of the macula with numerous, fine accretions on the outer retina (Fig. 1B). Fundus autofluorescence photography demonstrated punctate areas of intense autofluorescence within the isofluorescent serous detachment of the macula corresponding to the yellowish subretinal accretions (Fig. 1C).Case 2A 7-year-old girl was referred to evaluate a serous macular detachment in the left eye. She had had dimness of vision in the affected eye for 1 year. Visual acuity was 20/20 in the right eye and 20/30 (uncorrected) in the left eye. At fundus examination, there was an optic pit located at the inferotemporal border of the optic disk of the left eye with a shallow neurosensory macular detachment tapering toward the optic pit with yellowish subretinal precipitates (Fig. 2A). Autofluorescence photography demonstrated mottled hyperautofluorescence at the area of macular detachment from subretinal precipitates (Fig. 2B). OCT showed an outer-layer retinal detachment noncontiguous to the optic disk. There was hyperreflective accumulation of material on the outer part of the retina (Fig. 2C)Case 3A 26-year-old man presented with a decrease in vision and metamorphopsia in the left eye for 2 months. Best-corrected visual acuity was 20/20 in the right eye and 20/60 in the left eye. Examination revealed multiple subretinal precipitates within a large sensory detachment of the macula associated with a temporal optic nerve pit (Fig. 3A). Autofluorescence photography showed multiple punctate areas of hyperautofluorescence corresponding to the subretinal accretions within the subretinal fluid (Fig. 3B).DiscussionAccretions of intensely autofluorescent subretinal deposits were observed in our three consecutive cases of optic pit maculopathy. The yellow material was solely limited to the outer retina in areas of serous retinal detachment.