Optic disc pit (ODP) maculopathy

An optic disk pit (ODP) is a congenital round or oval depression in the optic disk. ODPs are usually unilateral, with an equal gender predilection. They are most commonly found at the inferotemporal aspect of the disk, but they may also be found elsewhere, including centrally.

Optic disk pit maculopathy cases are challenging to manage. When ODP maculopathy is present, visual acuity is usually reduced to 20/70 or worse. The majority of cases have a poor prognosis.

Current evidence suggests that the subretinal fluid associated with the maculopathy is most likely vitreous in origin. The etiology of the subretinal and intraretinal fluid associated with ODP maculopathy remains controversial, with several possible sources being proposed. 
It is postulated that vitreous traction on the retina, underlying the area of Martegiani and the bursa premacularis, leads to the development of a negative pressure gradient that draws fluid in through the optic pit and into the submacular space.

Pars plana vitrectomy has become the treatment of choice for ODP maculopathy. It has been proposed that induction of a complete PVD during surgery is essential for achieving macular reattachment by relieving the traction. The necessity of adjuvant surgical procedures remains unclear, but they include temporal ODP endolaser, internal limiting membrane peeling, and gas tamponade.