Optic disc pit maculopathy: A diagnostic challenge beyond glaucoma

Purpose: Optic disc pit maculopathy (ODP-M) is a rare but clinically significant anomaly that poses diagnostic and therapeutic challenges. This letter highlights the importance of comprehensive evaluation and management strategies for ODP-M through a recent case presentation. Case Presentation: A 34-year-old male with a 3-year history of glaucoma presented with decreased visual acuity in the right eye. Best-corrected visual acuity was 20/200 (OD) and 20/20 (OS), with well-controlled intraocular pressure. Fundus examination revealed an optic disc pit with macular elevation (OD). Optical coherence tomography (OCT) demonstrated diffuse macular edema, neurosensory detachment, and macular schisis. These findings confirmed the diagnosis of ODP-M rather than glaucoma. Discussion: ODP is a congenital optic nerve anomaly associated with maculopathy in some cases. The pathogenesis remains unclear, with proposed mechanisms including vitreous traction, cerebrospinal fluid infiltration, and hydraulic pressure gradients. Treatment options include gas tamponade, laser photocoagulation, vitrectomy, and inner limiting membrane peeling. Combination therapies and novel surgical techniques, such as macular buckling, offer promising outcomes for refractory cases. Conclusion: ODP-M is an uncommon yet critical condition requiring thorough differential diagnosis to avoid misclassification as glaucoma. A multidisciplinary approach, integrating advanced imaging and tailored therapeutic strategies, is essential for optimal patient management.