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Zhang X, Qiao G, Quan Y, He Y, Jiang H. Corneal stromal lenticule transplantation for the treatment of congenital optic disc pit maculopathy : a case report and review. BMC Ophthalmol 2024; 24:432. [PMID: 39367398 DOI: 10.1186/s12886-024-03707-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 10/01/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND Congenital optic disc pit (ODP) is a relatively uncommon congenital anomaly of the optic disc, which seriously affects the patient's vision when combined with optic disc pit maculopathy(ODP-M). Currently, the treatment of ODP-M remains a clinical challenge and a focus of research. CASE PRESENTATION A boy had a pit in the inferotemporal segment of the optic disc with ODP-M. Optical Coherence Tomography(OCT) showed ODP and serous retinal detachment. He was treated with pars plana vitrectomy(PPV), followed by Corneal Stromal Lenticule (CSL) sealing and C3F8 tamponade. In the end, significant anatomical improvement was achieved, and the Best Corrected Visual Acuity(BCVA) was improved. CONCLUSIONS The CSL transplantation may be a viable therapeutic option for improving ODP-M with stable anatomical and functional result. However, more cases and longer follow-up are needed to confirm the safety and effectiveness of the technology.
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Affiliation(s)
- Xiaojuan Zhang
- Fundus Disease Department, Mianyang Wanjiang Eye Hospital, Mianyang, 621000, Sichuan, China.
| | - Gang Qiao
- Fundus Disease Department, Mianyang Wanjiang Eye Hospital, Mianyang, 621000, Sichuan, China
| | - Yu Quan
- Fundus Disease Department, Mianyang Wanjiang Eye Hospital, Mianyang, 621000, Sichuan, China
| | - Yukun He
- Fundus Disease Department, Mianyang Wanjiang Eye Hospital, Mianyang, 621000, Sichuan, China
| | - Hui Jiang
- Fundus Disease Department, Mianyang Wanjiang Eye Hospital, Mianyang, 621000, Sichuan, China
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Feenstra HMA, van Dijk EHC, Cheung CMG, Ohno-Matsui K, Lai TYY, Koizumi H, Larsen M, Querques G, Downes SM, Yzer S, Breazzano MP, Subhi Y, Tadayoni R, Priglinger SG, Pauleikhoff LJB, Lange CAK, Loewenstein A, Diederen RMH, Schlingemann RO, Hoyng CB, Chhablani JK, Holz FG, Sivaprasad S, Lotery AJ, Yannuzzi LA, Freund KB, Boon CJF. Central serous chorioretinopathy: An evidence-based treatment guideline. Prog Retin Eye Res 2024; 101:101236. [PMID: 38301969 DOI: 10.1016/j.preteyeres.2024.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.
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Affiliation(s)
- Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Suzanne Yzer
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA; Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Siegfried G Priglinger
- Department of Ophthalmology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Laurenz J B Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Clemens A K Lange
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Ocular Angiogenesis Group, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jay K Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York, USA; Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
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Prabhu V, Venkatesh R, Kathare R, Acharya I, Mangla R, Handa A, Yadav NK, Chhablani J. Congenital versus acquired optic disc pit maculopathy: An OCT based study. Eur J Ophthalmol 2024; 34:1183-1190. [PMID: 37885202 DOI: 10.1177/11206721231210752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE The purpose of this study is to describe and compare the demographic, ocular, and imaging characteristics of a cohort of patients with congenital and acquired optic disc pit maculopathy (ODPM). METHODS This retrospective case series included patients diagnosed with ODPM between June 2017 and April 2023. These patients' baseline demographics, ocular characteristics, and optical coherence tomography (OCT) imaging characteristics and follow up changes were analyzed. RESULTS A total of 14 eyes with ODPM were identified (9 congenital and 5 acquired). Eyes with congenital ODP developed maculopathy at a younger age, presented commonly with visual symptoms, and exhibited an obvious pit at the temporal foveal margin as well as a high cup: disc ratio (p < 0.05). Primary open-angle glaucoma was identified in all five eyes with acquired ODPM. On OCT, eyes with acquired ODPM lacked the characteristic nerve fibre layer schisis, outer retinal layer hole, and foveal serous macular detachment (p < 0.05) unlike congenital ODPM. At the final follow-up visit, two cases from the congenital ODPM group and one case from the acquired ODPM group displayed complete resolution of maculopathy. The two cases of congenital ODPM were treated with pars plana vitrectomy and laser barrage to the optic disc margin, while the solitary case of acquired ODPM was treated with trabeculectomy surgery alone. CONCLUSION Clinical examination and baseline OCT imaging reveal distinct differences between congenital and acquired ODPM eyes. These characteristics may help with accurate diagnosis and treatment planning for these two distinct clinical entities.
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Affiliation(s)
- Vishma Prabhu
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Rupal Kathare
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Isha Acharya
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Rubble Mangla
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Ashit Handa
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
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Arora S, Zur D, Iovino C, Chhablani J. Peripapillary fluid: Obvious and not so obvious! Surv Ophthalmol 2024; 69:311-329. [PMID: 38016521 DOI: 10.1016/j.survophthal.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
Intraretinal or subretinal fluid in the peripapillary area can be clinically visualized in conditions such as peripapillary choroidal neovascularization, optic disc pit maculopathy, and optic nerve head tumors and granulomas. Optical coherence tomography (OCT) helps to visualize peripapillary fluid in many other chorioretinal conditions such as peripapillary pachychoroid syndrome, posterior uveitis, central retinal vein occlusion, malignant hypertension, hypotonic maculopathy as well as neuro-ophthalmological conditions such as glaucoma, microcystic macular edema and disc edema due papilledema, non-arteritic anterior ischemic optic neuropathy, neuroretinitis, and diabetic papillopathy. Often, the differential diagnosis of peripapillary fluid is a bit tricky and may lead to misdiagnosis and improper management. We describe a diagnostic algorithm for peripapillary fluid on OCT and outline the salient features and management of these conditions.
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Affiliation(s)
- Supriya Arora
- Bahamas Vision Centre and Princess Margaret Hospital, Nassau NP, Bahamas
| | - Dinah Zur
- Division of Ophthalmology, 26738 Tel Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, United States.
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Rice JC, Scholtz RP, Joseph J. SURGICAL DEMONSTRATION OF PRESSURE DIFFERENTIAL THROUGH AN OPTIC DISK PIT. Retin Cases Brief Rep 2024; 18:337-339. [PMID: 36730593 DOI: 10.1097/icb.0000000000001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/06/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To demonstrate intraoperative dynamic flow through an optic disk pit. METHODS Retrospective interventional case report. RESULTS Surgical management of an optic disk pit involved standard, 25-gauge, pars plana vitrectomy, induction of posterior hyaloid separation with triamcinolone stain, temporal peripapillary laser, and SF 6 gas. Intraoperatively, a remnant of stained vitreous at the optic disk head prolapsed into the optic disk pit with higher intraocular pressure but was drawn back into the vitreous cavity as the intraocular pressure was lowered. This clearly demonstrated a pressure differential across the pit. CONCLUSION Communication between the vitreous cavity and the perineural space of the optic nerve is described histologically. Our case demonstrated dynamic flow through the optic disk pit with intraoperative fluctuation of intraocular pressure.
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Affiliation(s)
- James C Rice
- Department of Ophthalmology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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Ishida T, Kita Y, Itoh Y, Mizuno M, Hirota K, Koto T, Inoue M, Hirakata A. Optical coherence tomographic findings of glaucomatous eyes with papillomacular retinoschisis. Eye (Lond) 2024; 38:266-273. [PMID: 37524830 PMCID: PMC10811323 DOI: 10.1038/s41433-023-02671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/25/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES To investigate the relationship between the shape of the optic nerve head (ONH) margin detected by optical coherence tomography (OCT) and the clinical characteristics of glaucomatous eyes with papillomacular retinoschisis (PMRS). METHODS The medical record of patients with a PMRS in a glaucomatous eye were reviewed. The eyes were placed into two groups determined by the shape of the ONH margin in the OCT images; eyes with an externally oblique ONH margin (Group 1) and eyes with an internally oblique ONH margin (Group 2). We compared the clinical characteristics of the PMRS of these two groups. RESULTS We studied 31 eyes of 29 patients with PMRS and glaucoma with 24 eyes in Group 1 and 7 eyes in Group 2. The optic nerve fibre layer schisis on the lamina cribrosa (LC), beta zone, and gamma zone, and found that the LC defects were detected significantly more frequently in Group 1 than in Group 2 eyes (P < 0.05). A retinal nerve fibre schisis was observed around the ONH significantly more frequently in Group 2 than in Group 1 eyes (P < 0.01). CONCLUSION The cases of glaucoma-associated PMRS could be classified into two groups according to the obliquity of the ONH. They had differences in the findings of OCT and FA. The possibility that the mechanism of PMRS development is different in both groups is suggested.
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Affiliation(s)
- Tomoka Ishida
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan.
| | - Yoshiyuki Kita
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan
| | - Yuji Itoh
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan
| | - Masaharu Mizuno
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan
| | - Kazunari Hirota
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan
| | - Takashi Koto
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan
| | - Makoto Inoue
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan
| | - Akito Hirakata
- Department of Ophthalmology, Kyorin University, School of Medicine, Tokyo, Japan
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Yousif JE, Miller JML. Intraocular Pressure Lowering Associated With Worsening Optic Pit-Like Retinoschisis. Ophthalmic Surg Lasers Imaging Retina 2024; 55:100-102. [PMID: 38198609 DOI: 10.3928/23258160-20231208-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
In this article, we present a case of optic pit-like macular retinoschisis in the absence of advanced glaucomatous cupping. Intraocular pressure (IOP)-lowering therapy, which was started due to an early concern for glaucoma, caused a worsening of the retinoschisis, which subsequently resolved on discontinuation of the IOP-lowering therapy. Lower IOP likely triggered intraretinal fluid accumulation by facilitating a translaminar gradient from the subarachnoid to intraretinal space. [Ophthalmic Surg Lasers Imaging Retina 2024;55:100-102.].
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Alrawashdeh HM. An unusual coexistence of iris mammillations and optic disc pit with keratoconus: A case report and literature review. Taiwan J Ophthalmol 2024; 14:125-128. [PMID: 38654990 PMCID: PMC11034683 DOI: 10.4103/tjo.tjo-d-22-00148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/29/2023] [Indexed: 04/26/2024] Open
Abstract
Iris mammillations are distinctive uniform nipple-like elevations that cover the anterior surface of the iris partially or totally. It is a rare finding and may coexist with other ocular and extraocular manifestations. Optic nerve pit (ONP), also known as optic disc pit (ODP) or optic hole, is a congenital defect resulting from the failure of fetal fissure closure during the embryonic development. It belongs to the congenital cavitary anomalies spectrum. This case presents a 19-year-old female patient who complained of a gradual decrease in visual acuity in both eyes for 4 years. Slit-lamp and fundus examinations revealed iris mammillations and ODP in the left eye. Corneal topography revealed bilateral keratoconus, which was managed with cross-linking. Iris mammillations and ODP are poorly understood ocular anomalies that are not reported frequently and have never been reported previously both combined with keratoconus. Thus, ophthalmologists should be aware of these conditions, their differential diagnosis, and their possible association with other disorders. This is the first reported case of the combined coexistence of iris mammillations and ODP with keratoconus.
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Chan C, Fries FN, Käsmann-Kellner B, Seitz B, Abdin AD. [Optic pit maculopathy: incidence and clinical course]. DIE OPHTHALMOLOGIE 2023; 120:1267-1272. [PMID: 37815542 DOI: 10.1007/s00347-023-01920-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/10/2023] [Accepted: 08/23/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE The aim of this case series was to investigate the clinical course of patients with optic pit maculopathy. METHODS The medical records of all patients diagnosed with optic pit maculopathy in the past 10 years were reviewed. Optic pit maculopathy was diagnosed when localized intraretinal or/and subretinal fluid spread from the optic nerve to the macula. Outcome measures included changes in best corrected visual acuity (BCVA), central retinal thickness (RT) as well as nasal parafoveal and perifoveal RT. RESULTS An optic disc pit was detected in 18 patients (9 female, 9 male, mean age: 33 ± 23 years). Retinal fluid accumulation was present in 6 (33.3%) of the patients (1 intraretinal, 1 subretinal, 4 intraretinal and subretinal). Pars plana vitrectomy with removal of peripapillary vitreous traction and peeling of the internal limiting membrane (ILM) was indicated in 5 patients and was performed in 4 patients. One patient underwent nanopulse laser treatment instead. The patients with optic pit maculopathy were 47 ± 16 years old. In this group of patients, mean BCVA (decimal) improved from 0.3 ± 0.2 before treatment to 0.5 ± 0.2 3 months after treatment (p = 0.03). Visual acuity improved in all patients with optic disc pit maculopathy after pars plana vitrectomy. The mean central RT decreased from 796 ± 214 before treatment to 324 ± 57 3 months after treatment (p = 0.005). The mean nasal parafoveal RT decreased from 683 ± 87 before treatment to 372 ± 41 (p = 0.0003) and the mean nasal perifoveal RT decreased from 547 ± 89 before treatment to 360 ± 48 (p = 0.007). A completely dry macula was achieved in 4 eyes after a mean follow-up of 3 months. At long-term follow-up (2.5 ± 1.2 years), no recurrence occurred in the vitrectomized eyes. CONCLUSION This case series showed that more than one third of the patients had optic pit maculopathy presumably caused by disruption of the Kuhnt intermediate tissue. Interventional treatment was indicated in all cases, of which 4 were surgically treated and resulted in significant improvement of function and anatomical retinal structures.
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Affiliation(s)
- Caroline Chan
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS in Homburg/Saar, Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland.
| | - Fabian Norbert Fries
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS in Homburg/Saar, Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Barbara Käsmann-Kellner
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS in Homburg/Saar, Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS in Homburg/Saar, Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Alaa Din Abdin
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS in Homburg/Saar, Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
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Anand A, Sinha S, Kumari A, Mohan N, Sinha BP. OPTIC DISK PIT STUFFING-TO DO OR NOT TO DO. Retin Cases Brief Rep 2023; 17:771-774. [PMID: 37903309 DOI: 10.1097/icb.0000000000001295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
PURPOSE Optic disk pit (ODP) is a subset of spectrum of congenital cavitary anomalies. Optic disk pit maculopathy causes progressive visual deterioration and is addressed with pars plana vitrectomy (PPV) with or without ODP stuffing. PATIENT AND METHODS We report a case of progressive ODP maculopathy who was taken up for 23-G 3-port PPV, with complete vitreous removal and stuffing of the ODP with autologous sclera and sequential analysis of change in the retinal nerve fiber layer (RNFL) thickness. RESULTS Spectral-domain optical coherence tomography RNFL analysis at 1 and 12 months follow-up postoperatively showed total RNFL thickness decrease from 130 µm to 103 µm respectively. Hemiquadrant analysis showed slight reduction of superior RNFL thickness from 142 µm to 139 µm. However, in the inferior hemiquadrant, the reduction in mean RNFL thickness seems to be significant from 133 µm to 100 µm at 1 and 12 months respectively. Sector-wise analysis of the RNFL thickness showed maximum reduction in the inferotemporal quadrant and other sectors seemed to be relatively preserved corresponding to the area of scleral stuffing. CONCLUSION Retrospective or prospective analysis of RNFL health of patients undergoing surgery for ODP-M with stuffing needs to evaluated.
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Boscia G, Sborgia G, Niro A, Dore S, Landini L, Scotti G, Boscia F. Management of unresolved optic disc pit maculopathy with human amniotic membrane patch implant: A case report. Eur J Ophthalmol 2023; 33:NP128-NP132. [PMID: 36823771 DOI: 10.1177/11206721231159692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND/PURPOSE Inverted Inner Limiting Membrane (ILM)-flap approach can fail in the treatment of Optic disc pit maculopathy (ODPM). We report a surgical technique involving human amniotic membrane (hAM) patch implant to treat unresolved ODPM after inverted (ILM)-flap technique. CASE REPORT One patient with decreased visual acuity (1 LogMar) after unsuccessful inverted ILM-flap technique to treat ODPM, underwent hAM patch implant and was evaluated. A surgical approach including a 2 mm size graft patch of hAM implantation over the optic disc pit followed by fluid-air exchange was performed. A gas endotamponade was finally used. The patient was instructed to maintain face-down position for the first three days after surgery. The hAM patch remained detectable over the pit for the entire 6-months follow-up. The ODPM gradually resolved and visual acuity partially recovered to 0.17 LogMar during follow-up. No postoperative complications or recurrence were reported. CONCLUSION hAM patch implant may be effective to manage ODPM after unsuccessful inverted ILM-flap.
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Affiliation(s)
- Giacomo Boscia
- Eye Clinic Section, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Giancarlo Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "SS. Annunziata", ASL Taranto, Taranto, Italy
| | - Stefano Dore
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luca Landini
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Giacomo Scotti
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Francesco Boscia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
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Khatri A, Shrestha SM, Prasai G, Pandit K, Bajgai P, Agrawal R, Gupta V. Minimally invasive procedure for optic disc pit maculopathy: vitrectomy with scleral plug and analysis on pattern of resolution. Sci Rep 2023; 13:15724. [PMID: 37735231 PMCID: PMC10514184 DOI: 10.1038/s41598-023-42839-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/15/2023] [Indexed: 09/23/2023] Open
Abstract
Optic disc pit maculopathy (ODP-M) is a rare complication of optic disc pit which can cause irreversible visual impairment. The aim of this study is to evaluate the anatomical and functional outcomes and pattern of resolution of ODP-M following vitrectomy with posterior vitreous detachment (PVD) induction and scleral tissue plug for treatment of ODP-M without ILM peeling, laser or use of long term gas/tamponade or head positioning. This retrospective study included 7 patients with ODP-M, meeting the inclusion criteria. Patients were followed up for 6 months. Complete anatomical success was defined as "Total resolution of all the fluid in retinal compartments". All of the patients had complete resolution of the optic pit maculopathy following surgery. The mean duration for complete resolution was 18.3 weeks. Pattern of resolution of ODP-M was found to be resolution of the subretinal fluid (SRF) followed by disappearance of the retinoschitic lesions (RL) and finally disappearance of macular edema (ME). The proposed minimally invasive procedure (MIP) can produce comparably good and equally reliable results for the treatment of ODP-M.
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Affiliation(s)
- Anadi Khatri
- Birat Eye Hospital, Biratnagar, Nepal.
- Birat Medical College and Teaching Hospital, Biratnagar, Nepal.
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA.
| | | | - Gunjan Prasai
- Tilganga Institute of Ophthalmology, Tilganga, Kathmandu, Nepal
| | - Kamal Pandit
- B.P Koirala Lions Centre for Ophthalmic Studies, Kathmandu, Nepal
| | | | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
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Palan P, Bhopalka AK, Takkar B. Intraoperative optical coherence tomography-guided management of optic-disc-pit maculopathy. BMJ Case Rep 2023; 16:e254884. [PMID: 37669826 PMCID: PMC10481729 DOI: 10.1136/bcr-2023-254884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Affiliation(s)
- Parth Palan
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | | | - Brijesh Takkar
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Econimics (IHOPE) Research Centre, Hyderabad, India
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14
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Venkatesh R, Sharief S, Arora S, Yadav NK, Chhablani J. Central visual field defects and optical coherence tomography angiography changes following congenital optic disc pit without maculopathy. Clin Exp Optom 2023; 106:809-812. [PMID: 35973408 DOI: 10.1080/08164622.2022.2111202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/14/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022] Open
Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, India
| | - Shama Sharief
- Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, India
| | - Sahil Arora
- Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, India
| | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
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Fujimoto S, Kokame GT, Ryan EH, Johnson MW, Hirakata A, Shirriff A, Ishikawa H, Adams OE, Bommakanti N. Macular Retinoschisis from Optic Disc without a Visible Optic Pit or Advanced Glaucomatous Cupping (No Optic Pit Retinoschisis [NOPIR]). Ophthalmol Retina 2023; 7:811-818. [PMID: 37271192 DOI: 10.1016/j.oret.2023.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE To review eyes with peripapillary and macular retinoschisis without a visible optic pit or advanced glaucomatous optic atrophy, or No Optic Pit Retinoschisis (NOPIR). DESIGN Retrospective multicenter case series. SUBJECTS The study included 11 eyes of 11 patients. METHODS Retrospective study of eyes with macular retinoschisis without a visible optic pit, advanced optic nerve head cupping, or macular leakage on fluorescein angiography. MAIN OUTCOME MEASURES Visual acuity (VA), retinoschisis resolution, months to resolution, and recurrence of retinoschisis RESULTS: The mean age was 68.1 ± 17.6 years, mean intraocular pressure was 17.4 ± 3.8 mmHg, and the mean spherical equivalent refractive error was -3.1 ± 2.9 diopters. No subject had pathologic myopia. Seven subjects were treated for glaucoma, and 9 subjects had nerve fiber layer defects on OCT. All eyes had retinoschisis in the outer nuclear layer (ONL) in the nasal macula and extending to the edge of the optic disc, and 8 subjects had fovea-involving retinoschisis. Three nonfoveal and 4 fovea-involved eyes were observed, and 4 fovea-involved eyes with vision loss underwent surgery. Surgery involved preoperative juxtapapillary laser followed by vitrectomy and membrane and internal limiting membrane peeling with intraocular gas and face-down position. The mean baseline VA was significantly worse in the surgery group than that in the observation group (P = 0.020). Retinoschisis resolved and vision improved in all surgical cases. The mean resolution time for the surgery group was 2.75 ± 0.96 months, which was shorter than that for the observation group (28.0 ± 21.2 months; P = 0.014). No eye developed recurrence of the retinoschisis after surgery. CONCLUSIONS Peripapillary and macular retinoschisis can develop in eyes without a visible optic pit or advanced glaucomatous cupping. Eyes without foveal involvement and those with foveal involvement but only mild decrease in vision can be observed for spontaneous resolution. If there is persistent foveal involvement with vision loss, surgery can improve vision by resolving the macular retinoschisis. Surgery for fovea-involved macular retinoschisis without a visible optic pit resulted in faster anatomic resolution and better vision recovery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | - Gregg T Kokame
- Hawaii Macula and Retina Institute, Aiea, Hawaii; University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii.
| | | | - Mark W Johnson
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Akito Hirakata
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ashley Shirriff
- University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii
| | - Hiroshi Ishikawa
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | | | - Nikhil Bommakanti
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
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Esmaeil A, Ali A, Almutairi S, Alkandari K, Behbehani R, Alali A. Congenital optic disc pits and optic disc pit maculopathy: a review. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1222979. [PMID: 38983028 PMCID: PMC11182116 DOI: 10.3389/fopht.2023.1222979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/31/2023] [Indexed: 07/11/2024]
Abstract
Optic disc pits are a rare but significant anomaly of the optic nerve head that can lead to visual impairment and associated complications. These pits are characterized by a small, oval-shaped depression in the disc, which can cause fluid accumulation and subsequent damage to the adjacent retina. Although the etiology and pathogenesis of optic disc pits are not fully understood, several theories have been proposed, including abnormal embryonic development and degenerative changes. Diagnosis is typically made through a comprehensive eye examination, including a dilated fundus exam and optical coherence tomography. Management options vary depending on the severity of the condition and associated complications, ranging from observation to surgical intervention.
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Affiliation(s)
- Ali Esmaeil
- Department of Ophthalmology, Adan Hospital, Hadiya, Kuwait
| | - Ali Ali
- Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Salman Almutairi
- Vitreoretinal Service, Department of Ophthalmology, Ibn Sina Hospital, Kuwait, Kuwait
| | - Khaled Alkandari
- Vitreoretinal Service, Department of Ophthalmology, Ibn Sina Hospital, Kuwait, Kuwait
| | - Raed Behbehani
- Neuro-Ophthalmology Service, Department of Ophthalmology, Ibn Sina Hospital, Kuwait, Kuwait
| | - Alaa Alali
- Vitreoretinal Service, Department of Ophthalmology, Ibn Sina Hospital, Kuwait, Kuwait
- Pediatric Service, Department of Ophthalmology, Ibn Sina Hospital, Kuwait, Kuwait
- Vitreoretinal Service, Dasman Diabetes Institute, Kuwait, Kuwait
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Prabhu V, Mangla R, Acharya I, Handa A, Thadani A, Parmar Y, Yadav NK, Chhablani J, Venkatesh R. Evaluation of baseline optic disc pit and optic disc coloboma maculopathy features by spectral domain optical coherence tomography. Int J Retina Vitreous 2023; 9:46. [PMID: 37550787 PMCID: PMC10405376 DOI: 10.1186/s40942-023-00484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
PURPOSE The aim of this study is to describe and compare the baseline demographic, ocular, and imaging characteristics of a cohort of patients with optic disc pit (ODP) or optic disc coloboma (ODC) maculopathy. METHODS This retrospective study included patients diagnosed with ODP or ODC on clinical examination between June 2017 and December 2022. These patients' baseline demographics, ocular characteristics, and optical coherence tomography (OCT) imaging characteristics were analyzed. RESULTS Fundus examination revealed 11 eyes of 11 patients with ODP and 14 eyes of 9 patients with ODC, respectively. On OCT, maculopathy was observed more frequently in ODP (n = 10) than in ODC (n = 4) [p = 0.004] cases. Eyes with ODP were more likely to exhibit retinoschisis and/or serous macular detachment [SMD] (n = 7, 70%), communication of the retinoschisis with the optic disc (p = 0.015), whereas the SMD did not communicate with the optic disc (p = 0.005), and significant outer retinal layer thinning (p = 0.015). In contrast, eyes with ODC exhibited only SMD (p = 0.005) and no retinoschisis on the non-colobomatous retina. SMD in ODC communicated with the margin of the optic disc. In both clinical entities, hyperreflective foci were observed in the SMD. CONCLUSION In summary, baseline maculopathy characteristics on OCT, including its type, location, and relationship to the optic disc, are among the most distinguishing characteristics between an ODP and an ODC. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Vishma Prabhu
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburgh, PA, 15213, USA
| | - Rubble Mangla
- Dept. of Retina and Vitreous, #121/C, Chord Road, 1st R block Rajaji Nagar, Bangalore, 560010, India
| | - Isha Acharya
- Dept. of Retina and Vitreous, #121/C, Chord Road, 1st R block Rajaji Nagar, Bangalore, 560010, India
| | - Ashit Handa
- Dept. of Retina and Vitreous, #121/C, Chord Road, 1st R block Rajaji Nagar, Bangalore, 560010, India
| | - Atul Thadani
- Dept. of Retina and Vitreous, #121/C, Chord Road, 1st R block Rajaji Nagar, Bangalore, 560010, India
| | - Yash Parmar
- Dept. of Retina and Vitreous, #121/C, Chord Road, 1st R block Rajaji Nagar, Bangalore, 560010, India
| | - Naresh Kumar Yadav
- Dept. of Retina and Vitreous, #121/C, Chord Road, 1st R block Rajaji Nagar, Bangalore, 560010, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburgh, PA, 15213, USA
| | - Ramesh Venkatesh
- Dept. of Retina and Vitreous, #121/C, Chord Road, 1st R block Rajaji Nagar, Bangalore, 560010, India.
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Lama H, Pâques M, Brasnu E, Vu J, Chaumette C, Dupas B, Fardeau C, Chehaibou I, Rouland JF, Besombes G, Labetoulle M, Labbé A, Rousseau A. Severe macular complications in glaucoma: high-resolution multimodal imaging characteristics and review of the literature. BMC Ophthalmol 2023; 23:318. [PMID: 37452284 PMCID: PMC10347769 DOI: 10.1186/s12886-023-03068-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
PURPOSE To describe imaging characteristics of severe macular complications occurring in glaucoma and discuss available treatments. METHODS Retrospective case series of glaucomatous patients with macular retinoschisis (MR) and/or serous retinal detachment (SRD). Patients underwent a complete ophthalmological examination and multimodal imaging including retinography, SD-OCT, fluorescein and indocyanine green angiography (FA & ICGA) and adaptive optics (AO). RESULTS Ten eyes (8 patients) were included. Initial BCVA was 1.04 ± 1.12 logMAR and IOP was 24.0 ± 9.3mmHg. All eyes presented with MR while SRD was present in 5 eyes (5 patients), with a central macular thickness of 573 ± 152 μm. FA and ICGA allowed to exclude leakage in all cases. A focal lamina cribrosa defect (LCD) was found in four eyes (4 patients) using OCT, with AO providing en-face visualization of the defect in one eye. Outer retinal hole was present in 3 eyes (3 patients). No visual improvement or resolution of the macular retinoschisis was observed in eyes with medical or surgical IOP control (N = 9). Vitrectomy with internal membrane limiting peeling and gas tamponade was performed in one eye with good visual results. CONCLUSIONS Multimodal high-resolution imaging is essential to diagnose severe macular complications associated with advanced glaucoma.
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Affiliation(s)
- Hugo Lama
- Department of Ophthalmology, Assistance Publique - Hôpitaux de Paris - Université Paris Saclay, 78, rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France
| | - Michel Pâques
- Department of Ophthalmology, Quinze-Vingts National Eye Hospital, IHU Foresight, Paris, France
| | - Emmanuelle Brasnu
- Department of Ophthalmology, Quinze-Vingts National Eye Hospital, IHU Foresight, Paris, France
| | - Jade Vu
- Department of Ophthalmology, Assistance Publique - Hôpitaux de Paris - Université Paris Saclay, 78, rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France
- Ophtalmopôle Cochin, APHP, Paris, France
| | - Céline Chaumette
- Department of Ophthalmology, Quinze-Vingts National Eye Hospital, IHU Foresight, Paris, France
| | - Bénédicte Dupas
- Department of Ophthalmology, Assistance Publique - Hôpitaux de Paris - Université Paris Saclay, 78, rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France
| | - Christine Fardeau
- Department of Ophthalmology, Assistance Publique - Hôpitaux de Paris - Université Paris Saclay, 78, rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France
- Department of Ophthalmology, Pitié Salpétrière Hospital, APHP, Paris, France
| | | | | | | | - Marc Labetoulle
- Department of Ophthalmology, Assistance Publique - Hôpitaux de Paris - Université Paris Saclay, 78, rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France
| | - Antoine Labbé
- Department of Ophthalmology, Quinze-Vingts National Eye Hospital, IHU Foresight, Paris, France
| | - Antoine Rousseau
- Department of Ophthalmology, Assistance Publique - Hôpitaux de Paris - Université Paris Saclay, 78, rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France.
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19
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Jalil A, Ziaei H, Ivanova T. AUTOLOGOUS RETINAL TRANSPLANT FOR REFRACTORY SEROUS RETINAL DETACHMENT SECONDARY TO OPTIC DISK PIT: A NOVEL SURGICAL APPROACH. Retin Cases Brief Rep 2023; 17:242-246. [PMID: 34580247 DOI: 10.1097/icb.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To present a new technique to treat refractory retinal detachment secondary to optic disk pit. METHODS An interventional case report. RESULTS A 25-year-old man with congenital optic disk pit had two failed vitrectomies involving laser around the optic disk, internal limiting membrane peel and flap to plug the disk pit, and gas tamponade to reattach the retina. With all options running out, a further vitrectomy with autologous retinal transplant and silicone oil tamponade was performed to treat the refractory serous retinal detachment; the silicone oil was removed at 6 weeks after the last procedure. The retina remained successfully attached at 6 months postsurgery with the patient maintaining his baseline visual acuity. CONCLUSION The use of autologous retinal transplant is a new approach to treat refractory retinal detachment secondary to congenital optic disk anomalies, and adds to our options of dealing with this complex condition when first-line approaches have failed.
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Affiliation(s)
- Assad Jalil
- Departments of Ophthalmology, Manchester Royal Eye Hospital, Manchester, Lancashire, United Kingdom
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20
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Abstract
PURPOSE To report a new surgical technique involving a human amniotic membrane patch (hAM) to solve a serous macular detachment associated with optic nerve head pit. METHODS Three eyes of three patients affected by macular detachment associated with optic nerve head pit were enrolled. A 23-gauge pars plana vitrectomy were performed. hAM patch was implanted inside the optic nerve pit; air was used as endotamponade. The patients were instructed to maintain face-down position for the first days after surgery. RESULTS The subretinal fluid gradually resolved during 6 months of follow-up, and visual acuity improved to 20/25 at the sixth month after surgery. We did not observe a recurrence of subretinal fluid during the 6 months of follow-up. No postoperative complications were reported during the follow-up. CONCLUSION Implant of the hAM may be effective to repair optic disk pit maculopathy. All the cases were successful with encouraging visual acuity recovery.
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21
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Muacevic A, Adler JR. A Classical Presentation of Optic Disc Pits With Complex Maculopathy. Cureus 2022; 14:e32469. [PMID: 36644100 PMCID: PMC9835849 DOI: 10.7759/cureus.32469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
A rare congenital abnormality of the optic disc, known as the optic disc pit (ODP), can cause progressive vision loss when it is associated with maculopathy. Only 15% of ODP cases are bilateral, with a reported incidence of 1 in 11,000 cases and with no gender differentiation. A 56-year-old woman presented in the outpatient department with a history of gradual painless diminution of vision in the right eye for one year. On ocular examination of the right eye, the patient has a vision of counting finger 1 m not improving with pinhole, and anterior segment evaluation is within normal limits. On fundus examination, we could appreciate a grayish, white small hypopigmented depression present in the inferotemporal part of the optic disc suggestive of ODP and edema present in the inferior half of the macula along with cystoid macular edema. The fundus photo of the right eye was suggestive of inferotemporal ODP in the right eye and normal fundus in the left eye. Optical coherence tomography (OCT) of the right eye showed inferotemporal ODP connecting with the subarachnoid space of the optic nerve. The macula showed diffuse edema extending from disc to macula, neurosensory detachment, macular schisis, and cystoid macular edema. We report a case of unilateral ODP maculopathy (ODP-M), which is a congenital anomaly of the optic nerve head (ONH) located at the inferotemporal part of the optic disc with multilayered separation involving all retinal layers and connecting with the subarachnoid space, as seen on OCT.
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22
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Nevin NV, Kulikov AN, Danilenko EV, Maltsev DS. Unusual Trigger for Contractile Movements of Optic Disc in Peripapillary Staphyloma. J Curr Ophthalmol 2022; 34:369-372. [PMID: 36644460 PMCID: PMC9832455 DOI: 10.4103/joco.joco_29_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 12/11/2022] Open
Abstract
Purpose To report a case of contractile movements of the optic disc in peripapillary staphyloma. Methods A 65-year-old female received a comprehensive ophthalmic examination, multimodal imaging, and computed tomography. Results The patient was diagnosed with peripapillary staphyloma in her right eye. Best-corrected visual acuity in her right and left eye was 20/32 and 20/40, respectively, with moderate cataracts in both eyes. Multimodal imaging revealed contractile movements of the optic disc in the right eye that were initiated by the circular rotation of the eye but by none of the triggers previously described in the literature. The patient reported no changes in her vision during contractile movements. Optical coherence tomography revealed a muscle-like structure in the optic disc during the peak of the contraction. Computed tomography did not reveal any abnormality of the optic nerve or the extraocular muscles of the right eye. Conclusion Contractile movements in peripapillary staphyloma may be initiated by previously unknown triggers. The pattern of the contractile movements and optical coherence tomography findings support the muscular nature of these movements.
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Affiliation(s)
- Nikolai V. Nevin
- Department of Ophthalmology, Military Medical Academy, St Petersburg, Russia
| | - Alexei N. Kulikov
- Department of Ophthalmology, Military Medical Academy, St Petersburg, Russia
| | | | - Dmitrii S. Maltsev
- Department of Ophthalmology, Military Medical Academy, St Petersburg, Russia,Address for correspondence: Dmitrii S. Maltsev, Department of Ophthalmology, Military Medical Academy, 21, Botkinskaya Str, St Petersburg 194044, Russia. E-mail:
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Aoki S, Imaizumi H. Vitrectomy for macular retinoschisis associated with peripapillary intrachoroidal cavitations in a moderately myopic eye. Int J Retina Vitreous 2022; 8:62. [PMID: 36064619 PMCID: PMC9446725 DOI: 10.1186/s40942-022-00409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background Peripapillary intrachoroidal cavitation (PICC), a cavernous change in the peripapillary choroid, may present with macular lesions. Here, we present a rare case of PICC with outer lamellar macular hole and macular retinoschisis. Case presentation A 69-year-old man presented with metamorphopsia in the left eye. Fundus examination revealed macular retinoschisis and PICCs. Pars plana vitrectomy with fovea sparing internal limiting membrane peeling (FSIP) was performed. Three weeks postoperatively, the patient developed rhegmatogenous retinal detachment and underwent a second vitrectomy. The macular retinoschisis resolved without macular hole formation and the patient’s visual acuity improved. There were no recurrent macular lesions over the three years of postoperative follow-up. Postoperative spectral-domain optical coherence tomography scan revealed a communication between the PICC and the vitreous cavity. Conclusions This case shed light on understanding development of PICC in non-highly myopic eyes and a rare complication of macular retinoschisis. Vitrectomy with FSIP may effectively resolve macular retinoschisis.
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Affiliation(s)
- Shuichiro Aoki
- Department of Ophthalmology, Sapporo City General Hospital, 13-1 Kita 11 West, Chuo-ku, Sapporo, 060-8604, Japan. .,Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hiroko Imaizumi
- Department of Ophthalmology, Sapporo City General Hospital, 13-1 Kita 11 West, Chuo-ku, Sapporo, 060-8604, Japan
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Non-vasogenic cystoid maculopathies. Prog Retin Eye Res 2022; 91:101092. [PMID: 35927124 DOI: 10.1016/j.preteyeres.2022.101092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Besides cystoid macular edema due to a blood-retinal barrier breakdown, another type of macular cystoid spaces referred to as non-vasogenic cystoid maculopathies (NVCM) may be detected on optical coherence tomography but not on fluorescein angiography. Various causes may disrupt retinal cell cohesion or impair retinal pigment epithelium (RPE) and Müller cell functions in the maintenance of retinal dehydration, resulting in cystoid spaces formation. Tractional causes include vitreomacular traction, epiretinal membranes and myopic foveoschisis. Surgical treatment does not always allow cystoid space resorption. In inherited retinal dystrophies, cystoid spaces may be part of the disease as in X-linked retinoschisis or enhanced S-cone syndrome, or occur occasionally as in bestrophinopathies, retinitis pigmentosa and allied diseases, congenital microphthalmia, choroideremia, gyrate atrophy and Bietti crystalline dystrophy. In macular telangiectasia type 2, cystoid spaces and cavitations do not depend on the fluid leakage from telangiectasia. Various causes affecting RPE function may result in NVCM such as chronic central serous chorioretinopathy and paraneoplastic syndromes. Non-exudative age macular degeneration may also be complicated by intraretinal cystoid spaces in the absence of fluorescein leakage. In these diseases, cystoid spaces occur in a context of retinal cell loss. Various causes of optic atrophy, including open-angle glaucoma, result in microcystoid spaces in the inner nuclear layer due to a retrograde transsynaptic degeneration. Lastly, drug toxicity may also induce cystoid maculopathy. Identifying NVCM on multimodal imaging, including fluorescein angiography if needed, allows guiding the diagnosis of the causative disease and choosing adequate treatment when available.
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Okano K, Ishida T, Inoue M, Hirakata A. Retinal detachment and retinoschisis associated with optic disc pit in peripapillary staphyloma. Am J Ophthalmol Case Rep 2022; 26:101468. [PMID: 35274065 PMCID: PMC8902472 DOI: 10.1016/j.ajoc.2022.101468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To determine the characteristics and clinical course of an eye with a peripapillary staphyloma and an optic disc pit associated with a retinal detachment (RD) and retinoschisis. Observations A 44-year-old woman had a peripapillary staphyloma with a shallow RD and retinoschisis in her right eye. The optic disc was located in the peripapillary staphyloma with steep walls, and an optic disc pit was located on the temporal area of the optic disc cup. Optical coherence tomography (OCT) revealed a separation of the lamina cribrosa, herniated retinal tissue, and a subarachnoid space corresponding to the optic disc pit. Pars plana vitrectomy with laser photocoagulation around the temporal margin of the peripapillary staphyloma was performed to treat the RD, and the treatment was successful. Conclusion and importance Clinicians should be aware that eyes with a RD and retinoschisis associated with a deep peripapillary staphyloma and an optic disc pit exist. The RD and retinoschisis can be successfully treated by vitrectomy.
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Kang HG, Kim JD, Lee J, Byeon SH, Kim SS, Kim M. Clinical features, treatment factors, and long-term outcomes of optic disc pit maculopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:2867-2875. [PMID: 35445878 DOI: 10.1007/s00417-022-05661-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To assess the clinical features, treatment factors, and long-term visual and anatomical outcomes of optic disc pit maculopathy (ODPM) in Korean patients. METHODS Consecutive patients diagnosed between January 2000 and September 2020 were retrospectively reviewed. The primary outcome was best-corrected visual acuity (BCVA) and anatomical changes (determined by macular thickness reduction and fluid resorption). Secondary outcomes included factors associated with poor visual outcomes (> 3-line decrease or < 20/200 vision). RESULTS Of the 24 eyes (24 patients, mean age, 42.8 years) in this study, two peak incidence groups were noted: children younger than 14 years (six patients; mean age, 9.7 years) and middle-aged adults (18 patients; 53.8 years). There were no significant differences between groups in terms of clinical features, treatment, and outcomes (P > 0.05). The primary treatment involved immediate (7 eyes) or delayed (9) vitrectomy, laser only (2), or observation only (6). Good (50%) or partial (33%) anatomical response was noted in most cases at the final follow-up (P > 0.05). However, regression analyses showed that poor visual outcomes were associated with low preoperative BCVA (OR, 8.73; 95%CI, 1.34-56.85; P = 0.023) and delayed vitrectomy (OR, 13.00; 95%CI, 1.70-99.38; P = 0.013), while presence of intraretinal fluid in the inner and outer layers reduced the risk (OR, 0.086; 95%CI, 0.01-0.88; P = 0.039). CONCLUSION Patients with ODPM may have two peak incidence groups with similar clinical features and treatment outcomes, supporting the idea of heterogeneous mechanisms triggering fluid accumulation. Although the primary treatment choice may not impact long-term anatomical outcomes, delayed vitrectomy may be associated with poorer visual outcomes.
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Affiliation(s)
- Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, Republic of Korea.,Translational Genome Informatics Laboratory, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Dong Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, 06273, Seoul, Republic of Korea
| | - Junwon Lee
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, 06273, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, Republic of Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, 06273, Seoul, Republic of Korea.
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Caporossi T, D'Amico G, Tartaro R, Governatori L, Scampoli A, Amorelli G, De Vico U, Rizzo S. Optic Disk Pit Maculopathy Treatment Using a Human Amniotic Membrane Patch: One-Year Results. Am J Ophthalmol 2022; 240:30-36. [PMID: 35227693 DOI: 10.1016/j.ajo.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To report the 1-year results of human amniotic membrane patch implantation for optic disc pit maculopathy. DESIGN A prospective, consecutive, interventional study. METHODS Eleven eyes of 11 patients affected by optic disc pit maculopathy associated with subretinal/intraretinal fluid were included in this single-institution study. A 25-gauge pars plana vitrectomy was performed in all cases, with an implant of a human amniotic membrane patch into the optic disc pit and air was injected as endotamponade. The primary study outcome was the subretinal and intraretinal fluid reabsorption. Secondary outcomes were visual acuity improvement and postoperative complications. RESULTS Mean central retinal thickness gradually diminished from 512 ± 137 µm to 243 ± 19 µm, at the 12-month follow-up. The mean visual acuity improved from 20/80 at baseline to 20/32 at the 12-month follow-up. Complete fluid resorption occurred in 9 of 11 (81.8%) eyes and there was partial resorption in 2 eyes (18%). No subretinal fluid recurrence was observed during the 12-month follow-up. No intraoperative or postoperative complications were reported during the follow-ups. The amniotic membrane patch remained detectable inside the pit for the entire follow-up time. CONCLUSION An amniotic membrane plug may be effective for improving optic disc pit maculopathy. All cases had an anatomical improvement and encouraging visual acuity recovery.
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Affiliation(s)
- Tomaso Caporossi
- From Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome (T.C, G.D'A, A.S, G.A, U.DeV, S.R)
| | - Guglielmo D'Amico
- From Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome (T.C, G.D'A, A.S, G.A, U.DeV, S.R)
| | - Ruggero Tartaro
- Department of NEUROFARBA, Ophthalmology, University of Florence, Careggi, Florence, Italy (R.T, L.G).
| | - Lorenzo Governatori
- Department of NEUROFARBA, Ophthalmology, University of Florence, Careggi, Florence, Italy (R.T, L.G)
| | - Alessandra Scampoli
- From Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome (T.C, G.D'A, A.S, G.A, U.DeV, S.R)
| | - Giulia Amorelli
- From Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome (T.C, G.D'A, A.S, G.A, U.DeV, S.R)
| | - Umberto De Vico
- From Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome (T.C, G.D'A, A.S, G.A, U.DeV, S.R)
| | - Stanislao Rizzo
- From Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome (T.C, G.D'A, A.S, G.A, U.DeV, S.R)
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Optic Pit Maculopathy: Clinical Features and Management Options. CURRENT OPHTHALMOLOGY REPORTS 2022; 9:158-167. [PMID: 35178287 DOI: 10.1007/s40135-021-00274-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose of Review In this article, we review the pathogenesis, clinical features, imaging modalities and latest management options for optic pit maculopathy (OPM). Recent Findings The pathogenesis of OPM remains to be unclear, but imaging tools such as optical coherence tomography (OCT) and OCT angiography are enhancing our knowledge. Observation continues to be the best management strategy for patients with good visual acuity, and many cases have demonstrated spontaneous resolution. For more advanced, progressive vision loss, treatment options involving vitrectomy can be considered and discussed with the patient. Supplementary techniques to vitrectomy have been reported in small studies with relative success such as glial tissue peeling, inverted internal limiting membrane flap, optic pit plugging, and retinal fenestration. Summary While there are multiple treatment options available for OPM, there is no consensus on the technique and surgical timing. Individual patient factors and the risks-benefits of treatment must be taken into account in guiding management. Larger clinical trials will further assist in decision making for treating OPM.
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The outcomes of intravitreal C 3F 8 gas tamponade combined with laser photocoagulation treatment for optic disc pit maculopathy. Int Ophthalmol 2022; 42:1819-1825. [PMID: 35088359 PMCID: PMC8794641 DOI: 10.1007/s10792-021-02179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022]
Abstract
Purpose To share the anatomical results and visual outcomes of intravitreal gas tamponade combined with laser photocoagulation treatment for optic disc pit maculopathy (ODPM).
Methods Intravitreal gas tamponade combined with laser photocoagulation treatment was performed on six consecutive patients with ODPM. A 0.3 mL of 100% perfluoropropane (C3F8) gas was injected intravitreally. The patients were then asked to maintain prone position until the C3F8 gas disappeared. Laser photocoagulation was performed the day after the procedure. The outcomes were determined by spectral-domain optical coherence tomography and best-corrected visual acuity (BCVA). Results In the present study, visual improvement and reduction in serous macular detachment were observed in 83% of the ODPM patients. Complete retinal reattachment was achieved in 66% of the ODPM patients. In one patient, no regression was observed after the repeated treatment, and pars plana vitrectomy was performed. The final BCVA improved in five eyes and unchanged in one eye. No postoperative complications were observed during the follow-up period in any patient. Conclusions Intravitreal C3F8 gas tamponade combined with laser photocoagulation procedure is an effective, minimally invasive, and cost-effective treatment method for ODPM.
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Hwang ES, Zolot AB, Kim JE. Macular Fluid in a Patient With a Reported History of Normal-Tension Glaucoma. JAMA Ophthalmol 2022; 140:278-279. [PMID: 34989766 DOI: 10.1001/jamaophthalmol.2021.3326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Eileen S Hwang
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee
| | - Andrew B Zolot
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee
| | - Judy E Kim
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee
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Jiang S, Turco B, Choudhry N. VASCULAR PERFUSION DENSITY MAPPING USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY COMPARING NORMAL AND OPTIC DISK PIT EYES. Retin Cases Brief Rep 2022; 16:126-132. [PMID: 31688795 DOI: 10.1097/icb.0000000000000908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Optic disk pits (ODPs) are typically detected incidentally as small, gray, unilateral, oval-shaped excavation in the temporal optic disk on routine fundus examination. In this cross-sectional retrospective case series, we report optical coherence tomography angiography findings in patients with unilateral ODPs and describe changes in vessel perfusion associated with ODP. METHODS A total of eight eyes (four with ODP and four normal contralateral) were included in this study. Patients were excluded if any other optic disk abnormalities were present. Spectral-domain optical coherence tomography angiography (AngioVue; Optovue, Fremont, CA) imaging was conducted to map the vascularization of three layers in the optic nerve over a 4.5-mm × 4.5-mm region. The radial peripapillary capillaries, the nerve head capillaries, and the choriocapillaris were automatically segmented based on the OCT system software, and the capillary perfusion density (CPD) was quantified for each layer. Kruskal-Wallis one-way analysis of variance was used to compare CPD in normal and ODP eyes of four patients with monocular ODP. RESULTS Overall, CPD was lower in eyes with ODP compared with the contralateral normal eye in the radial peripapillary capillary (0.4521 ± 0.08 vs. 0.5505 ± 0.03, P = 0.08) and nerve head capillary layers (0.5461 ± 0.08 vs. 0.5989 ± 0.01, P = 0.08). Significantly lower CPD values were associated with ODP eyes in the radial peripapillary capillary layer within the disk (P = 0.04), inferior nasal (P = 0.04), and temporal (P = 0.02) regions and in the nerve head vessel layer within the disk region (P = 0.04). Significantly higher CPD values were associated with ODP eyes in the choriocapillaris layer within the nasal (P = 0.02), superior temporal (P = 0.02), and inferior temporal (P = 0.02) regions. Visual acuity was also decreased in ODP eyes at 0.4 ± 0.3 logarithm of the minimum angle of resolution units (20/50) compared with normal eyes at 0.1 ± 0.1 logarithm of the minimum angle of resolution units (20/25) (P = 0.12). CONCLUSION This study demonstrated that the presence of an ODP is associated with decreased vascular density in some regions of the optic disk and reduced visual acuity.
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Affiliation(s)
- Shangjun Jiang
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bryen Turco
- Wayne State University School of Medicine, Detroit, Michigan
| | - Netan Choudhry
- Vitreous Retina Macula Specialists of Toronto, Etobicoke, Ontario, Canada; and
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
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Benador-Shen CL, Reichel E, Reed D, Milner LS, Pinnell N, Choi CS. Ocular phenotype in a patient with PAX2 gene mutation-associated papillorenal syndrome. Ophthalmic Genet 2021; 43:385-388. [PMID: 34889688 DOI: 10.1080/13816810.2021.2015786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Papillorenal syndrome is an autosomal dominant disorder associated with mutations in the gene PAX2 and often presents with characteristic and specific optic disc findings, frequently with renal dysplasia. In at least half of cases, an identifiable mutation in the PAX2 gene can be detected. We report the ocular findings in a second case of papillorenal syndrome with the c.350 G > C (p.Arg117Pro) mutation detected within the PAX2 gene. METHODS A case report of papillorenal syndrome due to PAX2 mutation. Complete ophthalmologic examination was performed as well as color fundus photography, fundus autofluorescence, and optical coherence tomography (OCT). Genetic testing was performed using a next-generation sequencing with CNV calling (NGS-CNV) panel test containing 55 genes associated with nephrotic syndrome or focal segmental glomerulosclerosis. RESULTS An 11-year-old boy who presented with hypertension and proteinuria was found to have stage IV chronic kidney disease. Presenting visual acuity was 20/25 in the right eye and 20/20 in the left eye. The fundus exam showed bilateral centrally excavated optic discs with absent central retinal vessels and a compensatory multiplicity of cilioretinal vessels, characteristic and specific for papillorenal syndrome. OCT showed outer retinal atrophy and macular schisis. Genetic testing identified the likely pathogenic c.350 G > C (p.Arg117Pro) mutation in PAX2. CONCLUSIONS We report the first description, to our knowledge, of the clinical presentation, ocular and systemic findings, and ophthalmic imaging in an individual with papillorenal syndrome associated with the PAX2 c.350 G > C (p.Arg117Pro) mutation. Our case adds to the current understanding of papillorenal syndrome and demonstrates that this condition is associated with a pathognomonic optic disc appearance and significant renal disease.
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Affiliation(s)
| | - Elias Reichel
- Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Dallas Reed
- Department of Pediatrics, Division of Genetics and Metabolism, Tufts Children's Hospital, Boston, Massachusetts, USA.,Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Lawrence S Milner
- Department of Pediatric Nephrology, Tufts Children's Hospital, Boston, Massachusetts, USA
| | - Nancy Pinnell
- Department of Pediatrics, Division of Genetics and Metabolism, Tufts Children's Hospital, Boston, Massachusetts, USA
| | - Catherine S Choi
- Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, USA
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Iros M, Parolini B, Ozdek S, Gini G, Nawrocka ZA, Ellabban AA, Faramawi MF, Adelman R, Sallam AB, Meireles A, Lee CS, Ducournau D, Tsouris D, Kozina E, Patelli F, Viola F, Ascaso F, Becquet F, Tosi GM, Besozzi G, Oh H, Othman IS, Fiser I, Le Rouic J, Perone J, Amar J, Nawrocki J, Nascimento J, Arrevola L, Nagpal M, Mehrotra N, Demir M, Chelazzi P, Miesbauer P, Turkcuoglu P, Koch P, Uy R, Weinfurter SB, Bopp S, Park S, Schönherr U, Alsanova V, Bonfiglio V, Szijárt Z. Management of optic disc pit maculopathy: the European VitreoRetinal society optic pit study. Acta Ophthalmol 2021; 100:e1264-e1271. [PMID: 34877796 DOI: 10.1111/aos.15076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/26/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate a variety of techniques, and their anatomical and functional results, for the treatment of optic disc pit maculopathy (ODP-M). A secondary aim was to report on results of secondary procedures in cases of initial failure or recurrence. METHODS Multicentre retrospective study of 95 eyes with ODP-M, treated by 25 surgeons from 12 countries. Primary outcomes were anatomical resolution of subretinal fluid (SRF), intraretinal fluid (IRF) and visual acuity (VA) at 12 months. RESULTS Higher rates of SRF and IRF resorption were achieved in eyes treated with pars plana vitrectomy (PPV) compared to external laser with or without tamponade: 64/72 (88.9%) versus 8/14 (57.1%) for SRF (p = 0.003), and 50/59 (84.7%) versus 3/10 (30%) for IRF (p = 0.002). The addition of juxtapapillary laser or internal limiting membrane (ILM) peel during PPV did not improve SRF or IRF resolution. Pars plana vitrectomy (PPV) with tamponade and PPV with tamponade plus endolaser were associated with significant visual gain. In the former group, VA improved from a mean of logMAR 0.91 (20/162), to a mean of logMAR 0.52 (20/66) at 12 months; in the latter group, VA improved from a mean of logMAR 0.82 (20/132) to a mean of logMAR 0.47 (20/59) at 12 months. Retreatments were performed in 14 eyes (15.7%), only enhancing anatomical outcomes. CONCLUSION Vitrectomy with tamponade had better final outcomes than external laser treatment with or without gas tamponade. Laser endophotocoagulation and ILM peel provided no additional benefit. A secondary treatment resulted in anatomical but not functional improvement.
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Affiliation(s)
- Mariano Iros
- Instituto de Microcirugía Ocular Córdoba Córdoba Argentina
| | | | - Sengul Ozdek
- Department of Ophthalmology Faculty of Medicine Gazi University Ankara Turkey
| | - Giampaolo Gini
- Western Sussex NHS Trust and Nuffield Haywards Heath Hospital Sussex UK
| | | | - Abdallah A Ellabban
- Hull University Teaching Hospitals Hull UK
- Department of Ophthalmology Suez Canal University Ismailia Egypt
| | - Mohammed F. Faramawi
- Departments of Bioinformatics and Epidemiology University of Arkansas for Medical Sciences Little Rock AR USA
| | - Ron Adelman
- Department of Ophthalmology Yale University New Haven CT USA
| | - Ahmed B. Sallam
- Jones Eye Institute University of Arkansas for Medical Sciences Little Rock AR USA
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Sano M, Hirakata A, Kita Y, Itoh Y, Koto T, Inoue M. Risk factors for failure of resolving optic disc pit maculopathy after primary vitrectomy without laser photocoagulation. Jpn J Ophthalmol 2021; 65:786-796. [PMID: 34505174 DOI: 10.1007/s10384-021-00866-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine factors significantly correlated with the failure of macular reattachment by pars plana vitrectomy (PPV) without laser photocoagulation of the optic disc margin to treat optic disc pit (ODP) maculopathy. DESIGN Retrospective, interventional case series. METHODS We reviewed the medical records of 35 consecutive patients with ODP maculopathy who underwent PPV without laser photocoagulation. PPV with the creation of a posterior vitreous detachment (PVD) was performed in 34 eyes. An epiretinal membrane and internal limiting membrane present in the other eye with a PVD were removed. Patients were followed for 12-193 months (mean 58 months) after surgery. The main outcome measures were the postoperative rate of retinal reattachment and best-corrected visual acuity. The preoperative clinical characteristics of the successful cases were compared to those of the unsuccessful cases. RESULTS A complete retinal reattachment was attained in 31 of 35 eyes and it required about one year. The 4 other eyes that did not achieve a macular reattachment after the primary PPV underwent additional therapies. The factors that were significantly associated with a failure of a retinal reattachment after primary PPV were the presence of a retinal detachment connected to the optic disc (P < 0.001) and the presence of preoperative headaches (P = 0.030). CONCLUSIONS Clinicians should be aware that the presence of a preoperative macular detachment connected to the optic disc margin and preoperative headaches are indicators for an unsuccessful outcome of PPV without laser photocoagulation in eyes with ODP maculopathy.
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Affiliation(s)
- Masahiko Sano
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Akito Hirakata
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Yoshiyuki Kita
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yuji Itoh
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Takashi Koto
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Makoto Inoue
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
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Singh DV, Sharma Y, Reddy RR, Sharma A. Arcuate Vitelliform detachment with morning glory disc maculopathy: OCT findings of evolution and resolution after early surgery. BMJ Case Rep 2021; 14:e244329. [PMID: 34315752 PMCID: PMC8317116 DOI: 10.1136/bcr-2021-244329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/04/2022] Open
Abstract
Morning glory disc (MGD) is known to develop secondary maculopathy and vision loss. We followed a 7-year-old girl with MGD in right eye from 2010 to 2021. Her best-corrected Snellen visual acuity (BCVA) was 20/20 in both eyes till 2017. She presented with reduced vision in right eye with BCVA of 20/80 in 2018. Optical Coherence Tomography (OCT) revealed maculopathy related to MGD in right eye and arcuate Vitelliform neurosensory detachment (V-NSD) temporal to fovea. She underwent 25G vitrectomy with internal limiting membrane peeling. Resolution of retinoschisis and V-NSD was analysed by OCT and fundus autofluorescence (FAF) postoperatively. Arcuate V-NSD was hyperfluorescent on FAF and concentric to optic disc. It resolved slowly with BCVA improving to 20/20 at 18 and 30 months postoperatively. We report excellent outcome following early vitrectomy for MGD-related maculopathy and recommend serial follow-up and considering early vitrectomy whenever traction and BCVA worsens. We also describe arcuate V-NSD with MGD.
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Affiliation(s)
| | - Yog Sharma
- Dr R P Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Raja Rami Reddy
- Retina Services, Neo Retina Eye Institute, Nampalli, Hyderabad, India
| | - Ajay Sharma
- Retina Services, Eye-Q Superspecialty Eye Hospitals, Gurugram, Haryana, India
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Muftuoglu IK, Tokuc EO, Karabas VL. Management of optic disc pit-associated maculopathy: A case series from a tertiary referral center. Eur J Ophthalmol 2021; 32:1720-1727. [PMID: 34132128 DOI: 10.1177/11206721211023727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report outcomes of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) stuffing technique in patients with optic disc pit associated maculopathy (ODP-M). METHODS Data including best-corrected visual acuity (BCVA), central macular thickness (CMT), foveal center point thickness (FCP), and maximum height of fluid (max_fluid) (intraretinal or subretinal) were collected from the medical records of the patients. RESULTS Six eyes of six patients with a mean age of 28.0 ± 17.68 years (range: 9-53 year) underwent PPV + ILM plug surgery. The mean follow-up duration was 25.62 ± 26.11 months (range: 11.80-78.00 month) duration. The mean BCVA increased from 1.25 ± 1.04 logMAR (20/355, Snellen equivalent) to 0.86 ± 1.09 logMAR (20/144, Snellen equivalent) at last follow-up (p = 0.043). Compared to baseline, CMT, FCP, and max_fluid significantly decreased at all visits after the surgery (p < 0.05 for all visits). At last follow-up, 66.6% of the eyes (four eyes) showed complete resolution of fluid at a mean of 5.25 ± 4.99 months (range: 1-12 months) after the surgery. CONCLUSION PPV with ILM plug seemed to be an effective surgical technique in ODP-M. Studies with longer follow-up and higher number of patients are needed to confirm our results.
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Affiliation(s)
- Ilkay Kilic Muftuoglu
- Istanbul Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Ecem Onder Tokuc
- University of Health Sciences Derince Training and Research Hospital, Department of Ophthalmology, Kocaeli, Turkey
| | - V Levent Karabas
- Kocaeli University School of Medicine, Department of Ophthalmology, Kocaeli, Turkey
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Kiziltoprak H, Tekin K, Dilli A, Teke MY. Retinal Vein Passing through a Congenital Optic Nerve Pit. J Ophthalmic Vis Res 2021; 16:308-311. [PMID: 34055271 PMCID: PMC8126749 DOI: 10.18502/jovr.v16i2.9101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/07/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Alper Dilli
- Diskapi Yildirim Bayazit Education and Research Hospital, Radiology Department, Ankara, Turkey
| | - Mehmet Yasin Teke
- Department of Retinal Diseases, Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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D'souza P, Verghese S, Ranjan R, Kumarswamy K, Saravanan VR, Manayath GJ, Narendran V. Optic Disc Pit Maculopathy: One-Year Outcomes of Pars Plana Vitrectomy with Foveal Sparing Inverted Internal Limiting Membrane Flap. Cureus 2021; 13:e14057. [PMID: 33777588 PMCID: PMC7986164 DOI: 10.7759/cureus.14057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate the anatomical and visual outcomes in optic disc pit maculopathy following pars plana vitrectomy (PPV) with inverted internal limiting membrane (ILM) flap Methods Retrospective interventional case series of 10 patients diagnosed with serous macular detachment secondary to optic disc pit who underwent PPV with inverted ILM flap and were followed up for a year. Results A p-value of less than 0.05 was defined as statistically significant. The mean age of patients was 27.2 ± 10.6 years, preoperatively the mean best-corrected visual acuity of the logarithm of the minimum angle of resolution was 0.91 ± 0.42 (approximate Snellen equivalent 20/162), which improved to the logarithm of the minimum angle of resolution of 0.58 ± 0.29 (approximate Snellen equivalent 20/76) at end of one year, (p=0.008). The mean central macular thickness was 804.9 ± 294.1 m which improved to 273.4 ± 102.54 m, (p=0.002). After surgery, at end of one year, 60% of patients (6/10) had 15- or more-than-15-letter improvement of vision on Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing, 20% (2/10) gained a 10-letter improvement and 20% (2/10) retained the same vision. Conclusion PPV with inverted ILM flap can be considered as a good approach for the management of serous macular detachment secondary to optic disc pit and produce good anatomical and visual results at one year with stabilization of the disease.
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Affiliation(s)
- Palmeera D'souza
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, IND
| | - Shishir Verghese
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, IND
| | - Ratnesh Ranjan
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, IND
| | - Karan Kumarswamy
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, IND
| | - Veerappan R Saravanan
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, IND
| | - George J Manayath
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, IND
| | - Venkatapathy Narendran
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, IND
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van Dijk EHC, Boon CJF. Serous business: Delineating the broad spectrum of diseases with subretinal fluid in the macula. Prog Retin Eye Res 2021; 84:100955. [PMID: 33716160 DOI: 10.1016/j.preteyeres.2021.100955] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/14/2021] [Accepted: 02/19/2021] [Indexed: 02/08/2023]
Abstract
A wide range of ocular diseases can present with serous subretinal fluid in the macula and therefore clinically mimic central serous chorioretinopathy (CSC). In this manuscript, we categorise the diseases and conditions that are part of the differential diagnosis into 12 main pathogenic subgroups: neovascular diseases, vitelliform lesions, inflammatory diseases, ocular tumours, haematological malignancies, paraneoplastic syndromes, genetic diseases, ocular developmental anomalies, medication-related conditions and toxicity-related diseases, rhegmatogenous retinal detachment and tractional retinal detachment, retinal vascular diseases, and miscellaneous diseases. In addition, we describe 2 new clinical pictures associated with macular subretinal fluid accumulation, namely serous maculopathy with absence of retinal pigment epithelium (SMARPE) and serous maculopathy due to aspecific choroidopathy (SMACH). Differentiating between these various diseases and CSC can be challenging, and obtaining the correct diagnosis can have immediate therapeutic and prognostic consequences. Here, we describe the key differential diagnostic features of each disease within this clinical spectrum, including representative case examples. Moreover, we discuss the pathogenesis of each disease in order to facilitate the differentiation from typical CSC.
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Affiliation(s)
- Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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Fernández-Engroba J, Saman M, Nadal J. Internal limiting membrane graft as a treatment for the retinal detachment secondary to an optic disc coloboma. Eur J Ophthalmol 2021; 31:2765-2768. [PMID: 33530723 DOI: 10.1177/1120672121992686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report our anatomical outcome with the internal limiting membrane (ILM) graft procedure in the management of rhegmatogenous retinal detachment (RRD) secondary to optic disc coloboma (ODC). METHODS Description of a new surgical procedure in one eye of one patient who underwent pars plana vitrectomy (PPV) combined with ILM graft technique. Subsequent follow-up included optical coherence tomography (OCT) and visual acuity. RESULTS After only 1 week, the OCT revealed the ILM graft plugging the retinal tear with complete resorption of subretinal fluid. The sealing effect of this graft persisted after 6 months. However, visual outcome was poor and corrected distance visual acuity was 20/200 as a result of the previous long-standing retinal detachment with loss of photoreceptors. CONCLUSION We suggest that ILM graft could be performed as a first line treatment in the management of RRD secondary to ODC. This direct closure of the retinal tears, allows a quick and effective interruption of the communication between the subretinal space and the vitreous cavity. Detecting these retinal tears and applying this technique as soon as possible could achieve not only an earlier anatomical success but obtain good visual results in retinal tears with RRD secondary to ODC. Further studies will be necessary to provide more evidences.
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Affiliation(s)
- Jorge Fernández-Engroba
- Centro de Oftalmologia Barraquer, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Muhsen Saman
- Centro de Oftalmologia Barraquer, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jeroni Nadal
- Centro de Oftalmologia Barraquer, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
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Occlusive retinal vasculopathy with macular branch retinal artery occlusion as a leading sign of atypical hemolytic uremic syndrome - a case report. BMC Ophthalmol 2021; 21:65. [PMID: 33516177 PMCID: PMC7847162 DOI: 10.1186/s12886-021-01820-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 01/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemolytic Uremic Syndrome (HUS) is a rare disorder characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure, considered within the group of thrombocytic microangiopathies. Ocular complications in HUS are very rare. Here, we report an adult patient who suffered from acute onset of paracentral scotoma, caused by branch retinal artery occlusion (BRAO), as a leading symptom of atypical HUS. CASE PRESENTATION A 39-year-old healthy male was lately diagnosed with essential hypertension and mild renal impairment. He complained about acute onset of central scotoma in his left eye. Fundus examination revealed marked narrowing of retinal vessels, cotton wool spots and few retinal hemorrhages in both eyes. The patient was diagnosed with bilateral ischemic retinal vasculopathy and acute macular BRAO in his left eye. Workup revealed thrombocytopenia, worsening renal failure. Renal biopsy showed signs of chronic thrombotic microangiopathy. The patient was diagnosed with atypical HUS (aHUS) and started on plasmapheresis, together with eculizumab. As his condition continued to worsen, he was put on renal replacement therapy. Due to a persistent monoclone of IgG1, the patient underwent bone marrow biopsy which revealed Monoclonal Gammopathy of renal significance, triggering a HUS and treatment was initiated accordingly. Two months after initial presentation, the patient developed neovascularization of the optic disc (NVD) in his left eye, and was treated with 3 monthly intravitreal bevacizumab injections with complete regression of the NVD. The patient suffered from myocardial infarction in the later course and was lost for follow-up. He returned 11 months after the last bevacizumab injection because of sudden loss of vision in his left eye caused by a dense vitreous hemorrhage. Biomicroscopy revealed a new NVD in his right eye. The patient underwent panretinal photocoagulation in both eyes with regression of neovascularization. Vision improved and remained 20/20 in both eyes. CONCLUSION We present a case report showing retinal ischemia can be linked with aHUS. As clinal diagnosis might be challenging, physicians should be aware of the rare ocular manifestations of this devastating multi-organ disease. In case of retinal ischemia, panretinal photocoagulation should be initiated soon to avoid blinding complications.
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Hwang I, Ugarte M. Morning glory disc anomaly-associated maculopathy: multimodal imaging. BMJ Case Rep 2021; 14:14/1/e237462. [PMID: 33462012 PMCID: PMC7813365 DOI: 10.1136/bcr-2020-237462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Morning glory disc anomaly (MGDA) is most commonly found in white females in childhood with reduced vision. One in two cases have been reported to develop maculopathy or posterior pole retinal detachment as they grow older. The pathophysiology of MGDA-associated maculopathy is not well understood.We describe a 31-year-old black woman, who presented with gradual reduction of vision in the right eye due to MGDA-associated maculopathy. We identified morphological characteristics of the optic disc and macula with multicolour and optical coherence tomography imaging.We speculate that the centripetal inner retina traction and cerebrospinal fluid pressure fluctuation play an important role in inner retinal fluid accumulation in the pathology of retinoschisis in MGDA. Further studies will shed some light of a potential cause-and-effect relationship between MGDA and retinoschisis.
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Affiliation(s)
- Inae Hwang
- The University of Manchester, Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, UK
| | - Marta Ugarte
- The University of Manchester, Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, UK,Manchester University NHS Foundation Trust, Manchester Royal Eye Hospital, Manchester, UK
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Cvetkov Y, Gamulescu A, Helbig H. Tageszeitliche Schwankungen subretinaler Flüssigkeit bei Grubenpapille. Klin Monbl Augenheilkd 2020; 237:1463-1465. [DOI: 10.1055/a-0972-9921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Yordan Cvetkov
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg
| | - Andreea Gamulescu
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg
| | - Horst Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg
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Makdoumi K, Crafoord S. A prospective long-term follow-up study of optic disc pit maculopathy treated with pars plana vitrectomy, drainage of subretinal fluid and peeling of internal limiting membrane. Acta Ophthalmol 2020; 98:822-827. [PMID: 32421253 DOI: 10.1111/aos.14475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the long-term results of surgical repair of patients with optic disc pit maculopathy (ODP-M). METHODS Prospective, consecutive, noncomparative follow-up study including 12 patients with ODP-M treated by pars plana vitrectomy (PPV), peeling of internal limiting membrane followed by gas tamponade. Subretinal fluid (SRF) was drained in 11 eyes through a retinotomy without laser photocoagulation. Preoperatively, macular detachment with retinoschisis was seen in 9 out of 12 eyes with three eyes having only subretinal fluid in the macular area. The median age at surgery was 20 years (range 9-60 years). RESULTS Follow-up time from initial surgery was 63 months (median). Eight eyes were anatomically reattached after one operation without remaining SRF in the macula. Two patients required a reoperation due to leakage from the retinotomy and another two underwent a second PPV procedure due to late recurrences. Successful healing was at follow-up control observed in 11 of 12 eyes. There was no statistically significant difference in visual acuity between patients before and after surgery (p = 0.24). Central visual field defects with depressed mean deviation were detected in all treated eyes. CONCLUSION In this long-term study of ODP-M final outcome regarding healing was relatively efficacious, however, a relatively large proportion had complications associated to retinotomies. We conclude that drainage of SRF should likely be avoided since it appears to contribute little to the resorption rate of SRF and seems to linked to unnecessary risks.
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Affiliation(s)
- Karim Makdoumi
- Department of Ophthalmology Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Sven Crafoord
- Department of Ophthalmology Faculty of Medicine and Health Örebro University Örebro Sweden
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Newly Onset Optic Disc Pit Maculopathy (ODP-M) in a Patient With Primary Angle-closure Glaucoma (PACG) After Surgical Iridectomy: A Case Report. J Glaucoma 2020; 29:e44-e49. [PMID: 32282435 PMCID: PMC7266000 DOI: 10.1097/ijg.0000000000001512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Supplemental Digital Content is available in the text. Optic disc pit maculopathy (ODP-M) is a subtype of ODP, characterized by a serous retinal detachment and/or macular retinoschisis. Currently, ODP and ODP-M pathogenesis remain unknown although many hypotheses exist about their clinical features. In this study, we report a case of new ODP-M detected after surgical iridectomy in a patient with primary angle-closure glaucoma (PACG) with a preoperative normal retina and optic nerve. Fine optic disc and the macular area structures were investigated using several imaging techniques. Findings revealed that the course of ODP and ODP-M provide us with some insights and understanding of their underlying pathogenesis.
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46
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Michalewska Z, Nawrocka Z, Nawrocki J. Swept-Source OCT and Swept-Source OCT Angiography before and after Vitrectomy with Stuffing of the Optic Pit. ACTA ACUST UNITED AC 2020; 4:927-937. [DOI: 10.1016/j.oret.2020.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 11/15/2022]
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Abdala-Caballero C, Vidal S, Unigarro J, Salgado C, Cabal P, Maeda H, Bueso Ponce D. Surgical technique: Autologous scleral flap for optic disk pit maculopathy. Eur J Ophthalmol 2020; 31:1487-1491. [PMID: 32787577 DOI: 10.1177/1120672120948731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To present a clinical case and surgical technique for management of optic disk pit (ODP) maculopathy. METHODS Surgical technique video of lens sparring pars plana vitrectomy, autologous scleral flap insertion and gas tamponade. RESULTS After 1 year follow-up visual acuity was restored to 20/25, retinal serous detachment and schisis were resolved and the autologous scleral flap remained in the (ODP). CONCLUSION In this case, treatment with pars plana vitrectomy autologous scleral flap insertion and gas tamponade for optic pit maculopathy provided satisfactory anatomical and functional results.
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Affiliation(s)
- Carlos Abdala-Caballero
- Retina and Vitreous Department, Grupo Oftalmológico Abdala-Figuerola, Barranquilla, Colombia
| | - Sofia Vidal
- Retina and Vitreous Department, Grupo Oftalmológico Abdala-Figuerola, Barranquilla, Colombia
| | - Juan Unigarro
- Retina and Vitreous Department, Grupo Oftalmológico Abdala-Figuerola, Barranquilla, Colombia
| | - Carlos Salgado
- Retina and Vitreous Department, Grupo Oftalmológico Abdala-Figuerola, Barranquilla, Colombia
| | - Pablo Cabal
- Retina and Vitreous Department, Grupo Oftalmológico Abdala-Figuerola, Barranquilla, Colombia
| | - Hiroshi Maeda
- Retina and Vitreous Department, Grupo Oftalmológico Abdala-Figuerola, Barranquilla, Colombia
| | - Diego Bueso Ponce
- Retina and Vitreous Department, Grupo Oftalmológico Abdala-Figuerola, Barranquilla, Colombia
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Abstract
SIGNIFICANCE Although the treatment of optic disc pit maculopathy is controversial, this review concludes that the most successful current intervention is pars plana vitrectomy with peeling of the internal limiting membrane and induction of posterior vitreous detachment.Initially described in 1882, an optic disc pit is a rare defect of the optic nerve. This anomaly can result in sight-threatening retinopathy in the form of macular detachment and/or schisis. Outlined in this review of the literature are the incidence, clinical presentation, ancillary testing, pathogenesis, and management of optic disc pits and optic disc pit maculopathy.
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Pastor-Idoate S, García-Arumí Fusté C, García-Onrubia L, Copete S, García-Arumí J. Surgical Options for Optic Disc Pit Maculopathy: Perspectives and Controversies. Clin Ophthalmol 2020; 14:1601-1608. [PMID: 32606575 PMCID: PMC7308761 DOI: 10.2147/opth.s250921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
Optic disc pit (ODP) is a rare congenital optic nerve head abnormality, which can be complicated by intraretinal and subretinal fluid at the macula (ODP-maculopathy) with progressive visual loss. The source of this fluid remains unclear and the most dominant hypotheses have pointed to vitreous cavity or cerebrospinal fluid. Although spontaneous resolution has been reported, the majority of untreated cases of ODP-maculopathy result in final visual acuity less than 20/200 or worse. A wide array of interventions, either individually or in combination with adjuvant treatments, have been tried with varying degrees of success. Recently, different surgical procedures to fill the ODP by self-sealing materials in combination with pars plana vitrectomy have been reported as an effective adjuvant treatment. However, given the relative rarity of this condition, the majority of reports describe a small retrospective case series, making it difficult to compare among different treatments options and create a consensus regarding the optimal treatment for ODP-maculopathy. In this situation, a mini-review about surgical treatment modalities and their results can be a useful approach to identify the most effective surgical option in the management of ODP-maculopathy.
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Affiliation(s)
- Salvador Pastor-Idoate
- IOBA Eye Institute, University of Valladolid, Valladolid, Spain.,Clinical University Hospital of Valladolid, Valladolid, Spain.,Red Temática de Investigación Cooperativa en Salud (RETICS), Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - Claudia García-Arumí Fusté
- Vall d´Hebron University Hospital, Barcelona, Spain.,Ophthalmology Research, Vall d´Hebron Research Institute (VHIR), Barcelona, Spain
| | | | | | - José García-Arumí
- Red Temática de Investigación Cooperativa en Salud (RETICS), Oftared, Instituto de Salud Carlos III, Madrid, Spain.,Vall d´Hebron University Hospital, Barcelona, Spain.,Ophthalmology Research, Vall d´Hebron Research Institute (VHIR), Barcelona, Spain.,Ocular Microsurgery Institute (IMO), Barcelona, Spain.,Department of Ophthalmology, Autonomous University of Barcelona, Barcelona, Spain
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AUTOLOGOUS NEUROSENSORY RETINAL TRANSPLANT TO TREAT REFRACTORY SEROUS RETINAL DETACHMENT SECONDARY TO OPTIC DISC COLOBOMA. Retin Cases Brief Rep 2020; 16:606-609. [PMID: 32568957 DOI: 10.1097/icb.0000000000001031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a novel surgical technique to treat refractory serous retinal detachment in a patient with an optic disc coloboma. METHODS Case report. RESULTS A 32-year-old male patient with an optic disc coloboma in his right eye was referred for recurrent retinoschisis and serous macular detachment despite multiple vitrectomies. Previous surgical procedures included peeling of internal limiting membrane and juxtapapillary laser as well as different tamponade agents such as sulfur hexafluoride gas, standard silicone oil and heavy silicone oil. Our first approach to close the cavity using autologous platelet concentrate and gas tamponade was also unsuccessful with early recurrence of the submacular fluid. In a second attempt we used an autologous neurosensory retinal transplant to cover the optic disc cavity. At seventeen months follow-up, the macula was still attached. As a postoperative complication, the patient developed high intraocular pressure, for which laser cycloablation eventually was necessary. CONCLUSION Autologous neurosensory retinal transplant may be a reasonable treatment option for patients with recurrent optic disc cavity associated maculopathy.
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