Choroid Involvement Secondary to Optic Disc Pit Maculopathy: OCT Analysis and Evolution After Surgical Treatment

Purpose: To assess choroidal changes associated to optic disc pit maculopathy (ODP-M) and their evolution after surgical treatment. Design: Multicentric retrospective case series. Methods: An analysis of 42 patients affected by unilateral ODP-M undergoing surgical treatment between 2013 and 2023 was conducted. Optical coherence tomography (OCT) was performed at baseline and postoperative months 1, 6, 12, and 24 and most recent follow-up. Subfoveal choroidal thickness (SFCT) and peripapillary choroidal thickness (PPCT) were measured in ODP-M and fellow eyes. The presence of retinal pigmented epithelium (RPE) atrophy was used to distinguish between "early" and "advanced" disease, and data regarding fluid localization were collected. Results: Baseline SFCT in ODP-M eyes was significantly higher than fellow eyes (386.8 ± 88.9 vs 334.4 ± 72.2 µm, P = 0.002), in contrast to PPCT (192.6 ± 47.8 vs 181.2 ± 45.7 µm, P = .46). SFCT significantly decreased 1 month postoperatively (mean reduction 36.5 µm, P = .009) and remained below preoperative values throughout the follow-up, showed a mean reduction of 79.4 µm at final follow-up (P < .001). Conversely, PPCT showed no changes between preoperative and postoperative values (all P > .05). Nine eyes (21.4%) showed submacular dilated choroidal vessels, correlated with the presence of subretinal fluid (P = .008) and reducing in caliber after surgical treatment. The 10 eyes (23.8%) with advanced disease had lower baseline SFCT and worse best-corrected visual acuity compared to the early disease subgroup, and showed a delayed reduction of choroidal swelling postoperatively. Conclusions: Subfoveal choroid may thicken and remodel in response to ODP-M, eventually returning to physiological values after surgical treatment. Moreover, the presence of RPE atrophy may influence retino-choroidal balance. Conversely, PPCT did not show comparable modifications.