Spontaneous resolution of optic disc pit maculopathy after posterior vitreous detachment

Inner retinal fenestration for paediatric optic disc pit maculopathy: a case series

OBJECTIVES

To evaluate the efficacy of inner retinal fenestration as a surgical technique for the treatment of optic disc pit maculopathy (ODPM) in the paediatric population.

METHODS

This is a retrospective, interventional case series of paediatric patients with ODPM treated at two tertiary hospitals in London by a single surgeon (SCW). All patients underwent pars plana vitrectomy with the creation of two inner retinal fenestrations and endogas tamponade. The partial-thickness retinotomies were made radial to the optic disc pit using a 25-gauge MVR blade. Anatomic and visual outcomes were determined by optical coherence tomography central retinal thickness and best-corrected visual acuity (BCVA), respectively.

RESULTS

A total of six eyes were included. Average patient age was 12.0 ± 3.5 years. Preoperatively all eyes demonstrated intraretinal fluid and/or serous detachment of the central macula. Patients were followed for a mean of 22.7 ± 16.1 months after surgery. Mean preoperative BCVA was logMAR 0.71 ± 0.29 (20/100). Mean postoperative BCVA was 0.49 ± 0.30 (20/63) at 2 weeks, 0.35 ± 0.33 (20/45) at 3 months and 0.16 ± 0.29 (20/32) at 1 year. Progressive resolution of intraretinal and subretinal fluid (SRF) was observed in all eyes, with central retinal thickness significantly improved by 2 weeks postoperatively (637.83 ± 209.09 µm preoperatively and 465.40 ± 169.86 µm postoperatively, p = 0.04). Recurrence of subretinal or intraretinal fluid was not observed.

CONCLUSION

Dual inner retinal fenestration is an effective technique that resolves fluid and restores vision in paediatric patients with ODPM. These results support the hypothesis that enabling egress of fluid into the vitreous cavity can achieve long-lasting amelioration of ODPM.

Resolution of Optic Disc Pit Maculopathy Following Posterior Vitreous Detachment

Purpose:

This work presents a case of significant improvement of optic pit disc maculopathy following an acute posterior vitreous detachment (PVD) and discusses the possible mechanisms of this phenomenon.

Methods:

A case report and review of the literature are presented.

Results:

A 56-year-old man presenting with progressive visual decline in his left eye was found to have an optic disc pit with optical coherence tomography (OCT) evidence of severe intraretinal edema and maculoschisis. His visual acuity and macular anatomy on OCT improved dramatically in the months following a PVD.

Conclusions:

This report presents an interesting case of spontaneous improvement of optic disc pit–related maculopathy following PVD. We discuss the cause of the retinal fluid accumulation in optic disc pit maculopathy and consider that the OCT findings in our case lend credence to the theory that this fluid originates from the vitreous humor.

Optic Disk Pit Maculopathy Treatment Using a Human Amniotic Membrane Patch: One-Year Results

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.

Optic disc pit with multiquadrant peripapillary retinoschisis and choroidal coloboma

An 18-year-old man presented with decreased vision in the right eye (OD) noticed for 1 month. On examination, OD best-corrected visual acuity was 3/60 and the left eye (OS) was 6/6 with intraocular pressure of 12 mm Hg in both the eyes (OU). OD fundus revealed an inferior optic-disc-pit with macular-retinoschisis and an inferior choroidal coloboma. OS fundus was normal. On swept-source optical coherence tomography (SSOCT) radial scans, peripapillary-retinoschisis was seen not only in the macular region but in all the four quadrants. To the best of our knowledge, no such case has been reported of optic disc pit with multiquadrant peripapillary retinoschisis and choroidal coloboma coexisting in the same eye. SSOCT radial scans can help detect subclinical retinoschisis as in this case.

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

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.

Spontaneous resolution of optic pit maculopathy: an OCT report

The separation of the vitreous from the optic nerve head and the macula plays a primary role in the spontaneous resolution of optic disc pit (ODP) maculopathy. Optical coherence tomography (OCT) helps in the non-invasive monitoring of this condition, when treated conservatively. The aim of this report was to describe a pediatric case of spontaneously resolved ODP maculopathy, managed conservatively and monitored by means of spectral domain (SD)-OCT. A 14-year-old girl presented with severe visual loss in the right eye (RE). Fundus examination demonstrated a temporal ODP with altered foveal reflex. The SD-OCT B-scans revealed severe intraretinal schisis-like changes, broad vitreal adhesion in the optic nerve head area, posterior hyaloid thickening, and vitreal entrapment in the premacular space. The patient was managed conservatively. Spontaneous resolution of ODP maculopathy took place over 3 months, with vision improved up to 1.0 (Snellen charts). The macular schisis progressively resolved after posterior vitreous detachment. In conclusion, in our report, a complete restoration of the foveal anatomy was achieved without any surgical intervention. This OCT-based report confirms the role of the vitreomacular abnormalities in the pathogenesis of the disease.

Optic Disc Pit Maculopathy - Case Series, Clinical Approach, and Management

PURPOSE

The purpose of this study was to analyze the diagnostic and therapeutic approach of five cases with optic disc pit (ODP) maculopathy.

MATERIALS AND METHODS

This was a retrospective study of five patients diagnosed with ODP maculopathy. Four of these cases had unilateral involvement, whereas one case had bilateral findings. The medical notes of these individuals were reviewed in order to record the presenting symptoms, clinical signs, visual acuity (VA), imaging, management, and the final visual outcome on their last follow-up appointment.

RESULTS

The first patient (53-year-old female) underwent a left pars plana vitrectomy (PPV) combined with inner retinal fenestration, endolaser, and perfluoropropane (C3F8) gas tamponade and her VA improved from 6/24 to 6/9 Snellen. A focal retinal laser treatment was carried out on our second patient leading to decrease of the subretinal fluid but had a poor visual outcome due to the underlying secondary glaucoma from iris melanoma treatment in the past. The third patient was an asymptomatic 7-year-old girl in which the maculopathy resolved spontaneously without any surgical intervention with a final VA of 6/5. The fourth and fifth patients were asymptomatic with good vision in both eyes and were, therefore, only monitored with follow-ups.

CONCLUSION

ODP maculopathy remains a challenging clinical entity for a vitreoretinal surgeon. The current management for ODP maculopathy involves surgical procedures with PPV being a common treatment of choice. Spontaneous resolution of ODP maculopathy has also been reported. Our study highlights the contrasting management that can be adopted in the treatment of ODP maculopathy, and there is not one definite treatment for this condition.

Optic disc pit maculopathy: a review of diagnosis and treatment

Optic disc pit is a rare congenital defect which appears as a circumscribed greyish depression in the lamina cribrosa. Serous macular detachment is one of the most visually debilitating complications of optic disc pit, affecting 25-75 per cent of patients. Although there is a wide variety of treatment modalities available with varying degrees of success, there is yet no consensus in the optimal management of optic disc pit-associated maculopathy. This review discusses the literature on the pathogenesis, clinical presentation, diagnosis and treatment options.

Role of the Epipapillary Membrane in Maculopathy Associated with Cavitary Optic Disc Anomalies: Morphology, Surgical Outcomes, and Histopathology

Purpose

To evaluate the surgical outcomes of pars plana vitrectomy (PPV) with epipapillary membrane removal in patients with maculopathy associated with cavitary optic disc anomalies.

Methods

Eight patients (8 eyes) with cavitary optic disc anomaly-associated maculopathy who underwent PPV with epipapillary membrane removal were retrospectively reviewed. The best-corrected visual acuity (BCVA) and macular and papillary morphologies using enhanced depth imaging optical coherence tomography (EDI-OCT) were evaluated before and after treatment. Immunohistochemistry for an intraoperatively excised epipapillary membrane tissue was also performed.

Results

Before surgery, EDI-OCT revealed that epipapillary membrane was observed in all patients. Retinoschisis was resolved with no recurrence in all patients following vitrectomy regardless of a disease type or the presence or absence of preoperative posterior vitreous detachment. The mean final BCVA and central retinal thickness significantly improved compared with pretreatment values (P = 0.008 and 0.004, resp.). Immunoreactivity for S100 protein and glial fibrillary acidic protein, markers of astrocytes, was positive in the resected membrane tissues.

Conclusions

These results suggest that epipapillary membrane is involved in the pathogenesis of some patients with cavitary optic disc anomaly-associated maculopathy as well as posterior hyaloid membrane. PPV with epipapillary membrane removal may be a useful treatment option for this maculopathy. This trial is registered with UMIN000011123.

Refined Internal Limiting Membrane Inverted Flap Technique for Intractable Macular Detachment with Optic Disc Pit

Purpose

To report a surgical technique for retinal detachment associated with optic disc pit (ODP) by using an internal limiting membrane (ILM) inverted flap as an obstacle between the vitreous cavity and subretinal space.

Case Presentation

A 43-year-old man presented with decreased visual acuity in the right eye for 1 week due to macular detachment associated with ODP. After 2 unsuccessful surgeries, the retina was reattached by vitrectomy with an ILM inverted flap onto the ODP.

Conclusion

Covering the pit with an inverted ILM flap is a reliable method for intercepting fluid from the vitreous cavity. Immediate absorption of subretinal fluid may lead to early macular attachment. This technique would be effective in managing ODP.

[Optic disc pit-associated maculopathy and iris-retinochoroidal-coloboma - a rare combination]

Kranenburg's syndrome is defined as central serous detachment associated with an optic disc pit. We report the interesting and very seldom combination of Kranenburg's syndrome and iris-retinochoroidal-coloboma. Reattachment was achieved after vitrectomy, peeling of epiretinal membranes, laser coagulation adjacent and temporal to the optic disc and gas endotamponade. Coincidence of this syndrome with an iris-retinochoroidal-coloboma is extremely rare. Both coloboma and optic disc pit are based on closure defects during week 6 of embryogenesis.