Serous macular detachment eventually occurs in 40% to 50% of patients with optic nerve pits. Although serous macular detachment is the most common sequela leading to vision loss in these patients, the origin of the fluid remains to be elucidated. Various theories have implicated fluid entry either from the vitreous cavity or from cerebrospinal fluid via the peripapillary subarachnoid space. In any case, the subretinal fluid causes a disruption of the normal retinal anatomy resulting in a lack of apposition between photoreceptor outer segments and retinal pigment epithelium (RPE). Interestingly, patients with serous detachment of the macula secondary to an optic nerve pit develop yellow subretinal flecks. Fundus autofluorescence photography in conjunction with optical coherence tomography has become essential in evaluating the photoreceptor-RPE complex. Autofluorescence photography can be used to monitor levels of fluorophore accretion in the subretinal space and RPE. We report the autofluorescence photography findings for three patients with subretinal fluid from optic pit maculopathy.
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