Occult Optic Disc Pit Maculopathy Masquerading as Exudative Age-Related Macular Degeneration in an Elderly Patient: A Case Report

Introduction: Occult optic disc pit maculopathy (ODPM) is a rare cause of macular retinoschisis in which no pit is visible on funduscopic examination. Optic disc pits are congenital cavitary anomalies thought to arise from incomplete closure of the embryonic fissure during ocular development. Case Presentation: An 83-year-old woman with a history of exudative AMD of the left eye (OS) and low-tension glaucoma had received 11 intravitreal anti-VEGF injections over approximately 18 months without resolution of macular fluid. Fluorescein angiography (FA) demonstrated no macular leakage and no macular neovascularization. Spectral-domain optical coherence tomography (SD-OCT) revealed multilayered peripapillary retinoschisis with fluid extending from the optic disc to the fovea. Dedicated optic disc OCT confirmed a deep craterlike excavation consistent with an occult optic disc pit. Anti-VEGF therapy was discontinued and the patient was observed. At approximately 10 months after the last injection, best-corrected visual acuity (BCVA) was stable at 20/25 OS with stable nasal macular cysts on OCT. Conclusion: Occult optic disc pit maculopathy can closely mimic exudative AMD and may go unrecognized for many months in elderly patients with coexisting retinal disease, resulting in repeated unnecessary anti-VEGF treatment.