A Case of Optic Pit Maculopathy Treated with Fovea-sparing and an Inverted Flap Technique

Purpose: To report a case of macular serous retinal detachment and macular thinning associated with optic disc pit maculopathy successfully treated with vitrectomy, fovea-sparing internal limiting membrane (ILM) peeling, and inverted ILM flap technique.Case summary: A 27-year-old male patient presented with a 1-month history of decreased right eye vision. Corrected visual acuity in the right eye was 0.025 at initial visit. Fundus examination revealed an oval, deep-seated defect in the inferotemporal portion of the optic nerve and a chorioretinal coloboma located inferior to the optic nerve with a one-third disc diameter. Optical coherence tomography (OCT) showed severe macular serous detachment and central foveal thinning. Surgical treatment comprised vitrectomy, ILM peeling preserving an amount of ILM equivalent to the diameter of one disc in the central fovea and covering the optic disc pit with an inverted ILM flap from its nasal portion. The flap was fixed with a dispersible viscoelastic material and intravitreal 20% sulfur hexafluoride gas injection. The patient was maintained in a facedown position for 3 days postoperatively. After 15 months, the best-corrected visual acuity of the right eye improved to 0.63. Repeat OCT revealed resolution of retinoschisis and serous retinal detachment, with the ILM flap effectively covering the optic disc pit.Conclusions: Fovea-sparing ILM peeling with an inverted ILM flap on the nasal side over the optic disc pit in patients with thin inner retinal layers and excessive serous retinal detachment effectively prevent the occurrence of macular holes and treat optic disc pit maculopathy.