Swept Source Optical Coherence Tomography Imaging of the Optic Pit Complex

Purpose: To reassess the anatomic basis of optic disc pit maculopathy (OPM) using swept-source optical coherence tomography (SS-OCT) and to characterize the broader structural abnormalities comprising the optic pit complex. Methods: Sixteen patients with OPM were imaged using a high-resolution SS-OCT system (DREAM OCT). Cross-sectional and volume-rendered scans were analyzed for lamina cribrosa defects, intraneural cavitations, and pathways for fluid entry into or beneath the retina. Results: All eyes demonstrated lamina cribrosa defects with associated cavitations extending a mean of 1855 ± 492 µm posterior to a modified Bruch’s membrane opening. Four distinct patterns by which fluid entered the retina were observed: (1) direct channels from cavitations into the retina, (2) perivascular hyporeflective spaces, (3) intraneural channels extending toward cystoid spaces, and (4) isolated retinal cysts without a visible interconnection. Vitreous remnants, trabecular structures, or disorganized connective tissue were found within the optic nerve pit in several eyes. In 13% of cases, the pit was not visible by ophthalmoscopy due to overlying tissue. These structural variations frequently coexisted, and associated abnormalities extended beyond the optic disc margins. Conclusions: OPM is associated with a spectrum of deep optic nerve abnormalities, collectively termed the optic pit complex. The combination of laminar disruption, cavitations, and multiple anatomic conduits for fluid ingress broadens the morphologic understanding of this condition. SS-OCT enables visualization of structures not accessible by ophthalmoscopy and may improve diagnostic precision, guide treatment decisions, and clarify the diverse mechanisms contributing to fluid accumulation in OPM.