Case Report: A rare case of myopic macular pit mimicking duplication of the optic disc

TL;DR

A rare case of myopic macular pit was initially mistaken for optic disc duplication but was correctly diagnosed using advanced imaging techniques.

Contribution

This case highlights the importance of multimodal imaging in distinguishing rare myopic macular pit from optic disc duplication.

Findings

The patient's lesion was initially misdiagnosed as optic disc duplication due to its disc-like appearance.

Multimodal imaging confirmed the diagnosis of myopic macular pit with chorioretinal atrophy and scleral excavation.

The case emphasizes the need for careful differentiation between MMP and optic disc duplication for accurate diagnosis.

Abstract

Myopic macular pit (MMP) is a rare manifestation of pathologic myopia. Here, we report a case of MMP with optic disc-like features that posed a diagnostic challenge and was misinterpreted as duplication of the optic disc.

A 69-year-old man with high myopia presented with visual impairment. Examination of his right eye revealed an axial length of 30.27 mm and best-corrected visual acuity of counting fingers at 10 cm. Fundus examination revealed a disc-sized pit within the macular atrophy, accompanied by radially oriented retinal and choroidal vessels. Owing to its disc-like appearance, the lesion was initially misdiagnosed as a duplication of the optic disc. Subsequent multimodal imaging established the correct diagnosis of MMP: orbital magnetic resonance imaging demonstrated a single optic nerve, fundus fluorescein angiography and indocyanine green angiography showed vascular filling consistent with short posterior ciliary arteries, and optical coherence tomography revealed chorioretinal atrophy and sharply curved scleral excavation.

MMP should be differentiated from true and pseudoduplication of the optic disc. Multimodal imaging plays a pivotal role in resolving this diagnostic challenge.

Figures