Vitrectomy with Inner Retinal Fenestration for Optic Disc Pit Maculopathy

Retinotomies and retinectomies: A review of indications, techniques, results, and complications

Retinotomy refers to "cutting" or "incising" the retina, whereas retinectomy denotes "excising" the retina. Retinotomies and retinectomies aid in tackling traction and retinal shortening that persist following membrane dissection and scleral buckling. We performed a literature search using Google Scholar and PubMed, followed by a review of the references procured. All relevant literature was studied in detail and summarized. We discuss the indications of retinotomies and retinectomies for relaxing retinal stiffness, accessing the subretinal space for choroidal neovascular membrane, hemorrhage and abscess clearance, drainage retinotomies to allow retinal flattening, radial retinotomies to release circumferential traction, harvesting free retinal grafts, and prophylactic chorioretinectomies in trauma.

Long-term outcomes of autologous platelet treatment for optic disc pit maculopathy

PURPOSE

Optic disc pits (ODPs) are rare congenital cavitary abnormalities of the optic nerve head, which can lead to serous macular detachments. The aim of this study was to evaluate the long-term efficacy of pars plana vitrectomy (PPV) combined with autologous platelet concentrate (APC) for the treatment of optic disc pit maculopathy (ODP-M).

METHODS

A retrospective analysis was performed on eleven eyes of ten patients with ODP-M, who received PPV combined with APC. Nine eyes operated primary, four of which had a repeat surgery also with injection of APC and two eyes underwent a rescue surgery, after they have been operated in another eye center without APC. Morphological and functional results were the main outcome parameters, determined by optical coherence tomography (OCT) and best-corrected visual acuity (BCVA), respectively.

RESULTS

The mean duration of visual loss before surgery was 4.7 ± 3.89 months (range 0-12 months). The mean BCVA increased significantly from 0.82 ± 0.33 logMAR (range 0.4-1.3) preoperatively to 0.51 ± 0.36 logMAR (range 0-1.2) at the last examination (p = 0.0022). A significant morphological improvement was also noticed with decrease of the mean foveal thickness from 935.82 ± 248.48 µm (range 559-1400 µm) preoperatively to 226.45 ± 76.09 µm (range 110-344 µm) at the final examination (p < 0.0001). The patients were followed-up for a mean 65.36 ± 48.81 months (range 1-144 months). Two eyes developed postoperatively a retinal detachment. Cataract surgery was performed in 5 eyes during the follow-up period.

CONCLUSION

Our study demonstrated that PPV with APC can improve functional and morphological outcomes, both as a primary and a rescue therapy, without any recurrence over a long follow-up period. To the best of our knowledge, this was the longest observation period regarding the use of APC in treatment of ODP-M.

Minimally invasive procedure for optic disc pit maculopathy: vitrectomy with scleral plug and analysis on pattern of resolution

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.

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 Pit Maculopathy: Clinical Features and Management Options

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.

The outcomes of intravitreal C3F8 gas tamponade combined with laser photocoagulation treatment for optic disc pit maculopathy

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.

Management of optic disc pit maculopathy: the European VitreoRetinal society optic pit study

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.

The characteristics of optic disc pit maculopathy and the efficacy of vitrectomy: a systematic review and meta-analysis

PURPOSE

To evaluate the basic characteristics of optic disc pit maculopathy (ODPM) and the efficacies of pars plana vitrectomy (PPV) treatment with different adjunctive strategies.

METHODS

The databases PubMed, EMBASE and Ovid up to April 2020 were searched to identify relevant studies. Statistical analyses were conducted with R software version 3.6.3.

RESULTS

Fifty-nine studies were eventually included for different aspects of statistical analyses. The pooling results suggest the general incidence of maculopathy in optic disc pit (ODP) is 51%, and the rate of serous macular detachment and retinoschisis is 49% and 58%, respectively. The incidence of sub-retinal fluid (SRF) only is 10%, intra-retinal retinal (IRF) fluid only is 14%, and SRF plus IRF is 69%. A lamellar macular hole (LMH) is present in 53% of cases, and 58% have communication between the macula with the pit. The incidence of posterior vitreous detachment (PVD), vitreo-papillary traction and vitreomacular traction (VMT) is 7%, 28% and 13%, respectively. Besides, the rate of complete anatomic success and visual improvement after PPV are both around 85%. Subgroup analysis reveals the anatomic, and visual success rates of PPV alone are 89% and 100%, respectively. Gas tamponade, laser or internal limiting membrane peeling (ILMP) during vitrectomy are less promising, while PPV with ILM flap stuffing could achieve better outcomes than cases without it.

CONCLUSION

Optic disc pit-associated maculopathy has different fundus characteristics. Based on the current evidence, PPV is effective for ODPM, and the combined application of gas tamponade, laser and ILMP should be used with caution.

Risk factors for failure of resolving optic disc pit maculopathy after primary vitrectomy without laser photocoagulation

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.

Ocular coloboma-a comprehensive review for the clinician

Typical ocular coloboma is caused by defective closure of the embryonal fissure. The occurrence of coloboma can be sporadic, hereditary (known or unknown gene defects) or associated with chromosomal abnormalities. Ocular colobomata are more often associated with systemic abnormalities when caused by chromosomal abnormalities. The ocular manifestations vary widely. At one extreme, the eye is hardly recognisable and non-functional—having been compressed by an orbital cyst, while at the other, one finds minimalistic involvement that hardly affects the structure and function of the eye. In the fundus, the variability involves the size of the coloboma (anteroposterior and transverse extent) and the involvement of the optic disc and fovea. The visual acuity is affected when coloboma involves disc and fovea, or is complicated by occurrence of retinal detachment, choroidal neovascular membrane, cataract, amblyopia due to uncorrected refractive errors, etc. While the basic birth anomaly cannot be corrected, most of the complications listed above are correctable to a great extent. Current day surgical management of coloboma-related retinal detachments has evolved to yield consistently good results. Cataract surgery in these eyes can pose a challenge due to a combination of microphthalmos and relatively hard lenses, resulting in increased risk of intra-operative complications. Prophylactic laser retinopexy to the border of choroidal coloboma appears to be an attractive option for reducing risk of coloboma-related retinal detachment. However, a majority of the eyes have the optic disc within the choroidal coloboma, thus making it difficult to safely administer a complete treatment.

Serous business: Delineating the broad spectrum of diseases with subretinal fluid in the macula

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.

Intraoperative optical coherence tomography-assisted displacement of prepapillary membrane in eyes with optic disc pit maculopathy

PURPOSE

To determine the efficacy of displacing a prepapillary membrane during vitrectomy assisted by intraoperative optical coherence tomography (OCT) to treat eyes with optic disc pit maculopathy.

METHOD

Pars plana vitrectomy was performed with 27-gauge instruments on 4 eyes of 4 consecutive patients for optic disc pit maculopathy with retinoschisis and foveal detachment. After creating a posterior vitreous detachment, the prepapillary membrane was made visible by brilliant blue G staining. The membrane was peeled from the central retinal vessel and inverted and placed over intraretinal clefts or stuffed into the optic disc pit. These procedures were guided by intraoperative OCT. A gas tamponade and peripapillary laser was not used. The preoperative and postoperative OCT images and surgical outcomes were evaluated.

RESULT

Intraretinal clefts connected to an inner retinoschisis were detected at the edge of the optic disc pit in 3 eyes with intraoperative OCT and 2 eyes with preoperative OCT. The foveal detachment and retinoschisis were resolved completely in all 4 eyes at postoperative 13 to 15 months. The postoperative vision improved from 20/25 to 20/18 at the final examination in all eyes.

CONCLUSION

Intraoperative OCT can detect intraretinal clefts at the edge of the optic disc pit, and the OCT images are helpful in guiding the peeling and placement of the prepapillary membrane to achieve anatomical and visual recovery.

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.

Topical Review: Optic Disc Pits and Associated Maculopathy

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.

[Partial retinal fenestration for optic disc pit maculopathy]

The frequent side effect of maculopathy in the optic disc pit seems to be based on a pathogenetically incompletely comprehended fluid exchange between the optic disc and the macula. A surgical procedure using vitrectomy with the creation of a barrier between the macula and the optic disc pit, for example using an endolaser or a scleral flap, is possible. In addition, the partial retinal fenestration as described here in detail represents an alternative surgical procedure resulting in liquid being conducted from the optic disc pit into the vitreous cavity. Complete absorption of the subretinal and intraretinal fluid can be expected within the first postoperative year.

Surgical Options for Optic Disc Pit Maculopathy: Perspectives and Controversies

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.

Thoughts and Challenges for the Current Treatment of Optic Disc Pit Maculopathy

PURPOSE

The present review describes the procedures that intervene directly in covering and stuffing the optic disc pit (ODP).

METHODS

We made a comprehensive review of the literature regarding the new treatment modalities for the treatment of ODP maculopathy, mainly concentrated on covering and stuffing of the ODP. We presented the anatomical and functional outcomes of these techniques in patients with ODP maculopathy, while potential risks and complications of these techniques are also discussed.

RESULTS

The most commonly used treatment alternative for ODP maculopathy is vitrectomy, which seems to be more successful if it is associated with the covering of the ODP by internal limiting membrane (ILM) inverted flapping. The results of the procedure are successful, if the origin of the fluid comes from the vitreous cavity. Another new procedure aims at the stuffing of the ODP by rolled ILM-flap, autologous scleral tissue or human amniotic membrane, providing promising anatomical results. The so far anatomical and functional results are discussed in detail. The literature, however, is limited regarding these techniques and based mainly on case reports with short-term follow-up. Additionally, the stuffing technique is possible to provoke further damage of optic nerve tissue and remain challenging in its use.

CONCLUSIONS

Both covering and stuffing techniques of the ODP seem to have promising results, when used as adjunct to vitrectomy. One should take into account special considerations and possible further complications for their use in the treatment of ODP maculopathy.

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.

Sulphur hexafluoride (SF6) intravitreal injection combined with argon laser photocoagulation for treatment of optic disc pit maculopathy

PURPOSE

To evaluate clinical efficacy of combined sulphur hexafluoride (SF6) gas tamponade and laser photocoagulation for optic disc pit maculopathy (ODPM).

METHODS

Eleven eyes of nine patients with optic disc pit maculopathy were treated with intravitreal injection of 0.6 ml 100% sulphur hexafluoride (SF6) combined with laser photocoagulation treatment. Patients were followed up for a mean of 28.54 months (range of 14-57 months) after treatment. The anatomical success was shown by optical coherence tomography (OCT) and the functional outcome was judged by best corrected visual acuity.

RESULTS

Treatment with SF6 gas tamponade followed by laser photocoagulation in OPDM patients resulted in resolution of subretinal fluid (SRF) in 82% of eyes after single injection. Repeated injection was needed in two eyes to achieve resolution of SRF. Visual acuity improved significantly from a mean of 0.83 ± 0.14 logMAR preoperatively to a mean of 0.26 ± 0.11 logMAR postoperatively. Visual acuity stayed stable throughout the follow-up period.

CONCLUSIONS

SF6 gas tamponade combined with laser photocoagulation represents simple, effective, minimally invasive treatment option for ODPM without vitreomacular traction. Repeated injection was required in some patients.

Optic Disc Pit Maculopathy: New Perspectives on the Natural History

PURPOSE

To investigate the natural history of optic disc pit maculopathy and explore the associations between demographic, anatomic, and functional characteristics.

DESIGN

Retrospective, comparative case series.

METHODS

This was a single-center medical record review of previously untreated optic disc pit maculopathy. Baseline data of visual function, demographics, and pit physiognomy were collected, and further subgroup analysis was undertaken on patients with long-term follow-up, according to whether they were monitored or received surgical intervention. LogMAR visual acuity was the primary outcome measure, and anatomic characteristics were reported where available.

RESULTS

Eighty-seven patients were identified with a new presentation of optic disc pit maculopathy. No demographic or pit features were correlated with vision at baseline. In 51 patients with available optical coherence tomography data, only the presence of subretinal fluid at baseline was associated with poorer visual acuity (P < .001). Fifty-two patients who were monitored without treatment had available long-term follow-up data. The mean change in visual acuity in this group was 0.01, with 77% maintaining visual acuity ≤0.30. Twenty-seven patients underwent surgery and showed significant postoperative improvement in vision (P < .001), with 59% achieving an acuity ≤0.30. Duration of postoperative follow-up was associated with better visual acuity (P = .007).

CONCLUSION

Many patients with optic disc pit maculopathy maintain good long-term visual acuity and may demonstrate resolution of subretinal fluid in the absence of surgical intervention. There may be evidence to support delaying surgical treatment until visual deterioration is observed because of the potential stability or spontaneous improvement of the condition, the high rate of reoperation, and the long-term positive outcomes of deferred intervention.

Optic disc pit maculopathy: tamponade of maculoschisis

Purpose

To present rapid and safe closure of the pit-macula communication (PMC) by core vitrectomy and adequate duration gas tamponade as our preferred method of resolving optic disc pit (ODP) maculopathy and to define the term "maculoschisis" in ODP maculopathy as an alternative to the term "schisis-like."

Patient and methods

A twenty-four-year-old female presented with an optical coherence tomography (OCT) confirmed ODP and a "giant" communicating maculoschisis cavity. Central macular thickness (CMT) measured 906 microns, and macular volume was twice normal, at 20.8 mm³. Snellen corrected visual acuity was 20/70. Two months after initial vitrectomy performed elsewhere with short-term gas tamponade (SF₆ 20%), CMT and visual acuity were not significantly improved. Combined lens extraction/intraocular lens placement and repeat vitrectomy with C₃F₈ 15% gas tamponade were performed, with one supplemental (office) gas injection.

Results

OCT imaging six weeks postoperatively showed definitive closure of the PMC with CMT reduced by 405 microns. Sequestered from its ODP source, foveal schisis fluid then resolved by 12 weeks postoperatively. At final follow-up 3.4 years postoperatively, the macula remained dry with a CMT of 322 microns and a concave foveal contour. Macular volume was reduced to (a normal) 10.2 mm³ and visual acuity had improved to 20/25.

Conclusion

No report heretofore has documented rapid, sustained closure of the PMC by gas tamponade as the preferred method of expeditiously resolving ODP maculopathy. However, tamponade PMC closure sequesters ODP fluid and uniquely provides early assurance of ultimate maculopathy resolution. In all other techniques, PMC closure is a trailing phenomenon and success remains uncertain during months to a year or more of (unsequestered) fluid resolution. We suggest that more invasive techniques (laser barrier application to the peripapillary choroid, vitreoretinal interface maneuvers, and pit-plugging) be withheld unless a recurrence is detected during subsequent examinations.

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.

Optic disk pits and optic disk pit maculopathy: A review

Optic disk pit, one of the optic disk cavitary anomalies, is generally congenital and unilateral and occurs equally in males and females. Optic disk pit maculopathy is characterized by intraretinal and subretinal fluid at the macula, causing visual deterioration. The origin of the macular fluid and the mechanism of transition to the subretinal space in optic disk pit maculopathy pathophysiology are not yet fully understood. With the evolution of imaging modalities, especially optic coherence tomography, our knowledge of this disorder continues to increase. Although many different treatments have been tried, there is no consensus on the most effective.

Optic disk pit maculopathy: current management strategies

Introduction

Optic disk pit (ODP) is a rare congenital abnormality of the optic nerve head and can lead to visual impairment when macular detachment occurred. Recent advances in retinal imaging brought new insights into the pathophysiology of the disease, while new therapeutic options have been also described.

Methods

We made a comprehensive search of the literature regarding the current treatment modalities for the treatment of ODP maculopathy.

Results

Although there have been reported some cases of spontaneous resolution, current management of ODP maculopathy involves several surgical approaches. The most commonly used treatment alternative for ODP maculopathy management is vitrectomy, either alone or in combination with other treatment modalities, such as gas tamponade or laser photocoagulation. Other options, such as scleral buckling and inner fenestration, are also used, based on the recent findings about pathophysiology of the disease.

Conclusion

The management of ODP maculopathy remains challenging. Even though there are further advances in the understanding of the disease pathophysiology, the applied treatment is not single and therapeutic modalities differ in the success rate, related to the anatomical and functional results.

Optic Disc Pit Maculopathy: A Two-Year Nationwide Prospective Population-based Study

PURPOSE

To identify the incidence, presenting features, treatment, and clinical course of optic disc pit maculopathy (ODPM) in the United Kingdom (UK).

DESIGN

A 2-year nationwide prospective population-based study.

SUBJECTS

All new incident cases of ODPM presenting to UK ophthalmologists using the British Ophthalmic Surveillance Unit monthly reporting system.

METHODS

All reporting ophthalmologists were sent an initial questionnaire requesting data on previous medical and ophthalmic history, presentation details, investigation findings, and management. A further questionnaire was sent at 12 months post diagnosis to ascertain further outcome data.

MAIN OUTCOME MEASURES

Visual acuity at initial presentation, at 1 year, and after any intervention. Foveal involvement and optical coherence tomography (OCT) findings, including retinal layers affected, and the location and size of the optic disc pit. Management, including observation, vitrectomy, and associated procedures.

RESULTS

There were 74 confirmed new cases, giving an annual incidence of approximately 1 per 2 million. Complete data were available on 70 patients (70 eyes) at baseline and 68 after 1 year. There were 35 (50%) female patients with a mean age of 35 years (range, 3-82 years). Visual acuity at baseline ranged from 6/5 to hand movements. In 43 patients (61%) subretinal fluid (SRF) was present, whereas 27 (39%) had intraretinal fluid only. The presence of SRF was associated with worse vision and foveal involvement. Of the 53 eyes initially observed with 1-year follow-up, 10 (19%) deteriorated and 9 (16%) improved on OCT; eyes with SRF were more likely to worsen and those without SRF were more likely to improve. Fifteen of the 70 patients (21%) at baseline had primary surgery and a further 10 had deferred surgery within 1 year of presentation; 19 of these 25 eyes (76%) showed anatomic success with a dry fovea at 1 year of follow-up, and 15 (60%) had a greater than 0.1 logMAR improvement in visual acuity.

CONCLUSION

The incidence and presenting features of ODPM were defined. Patients with SRF had worse vision and were more likely to deteriorate than patients with intraretinal fluid only. Surgery was anatomically successful in 75% of cases. Patients without SRF tended to remain stable with observation.

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.

Vitrectomy for optic disc pit maculopathy: a long-term follow-up study

PURPOSE

To evaluate the clinical outcomes of vitrectomy with induction of posterior vitreous detachment for the treatment of optic disc pit maculopathy.

METHODS

We retrospectively evaluated medical records and imaging studies of 11 consecutive patients with optic disc pit maculopathy who underwent vitrectomy at Sacco University Hospital, Milan, Italy, between October 2008 and December 2015. Induction of a posterior vitreous detachment (PVD) was the aim of our surgery. Intravitreal injection of ocriplasmin (Jetrea, Thrombogenics USA, Alcon/Novartis EU) was performed before surgery in three eyes of very young patients. Gas tamponade (sulfur hexafluoride (SF6) 20%) was used only in the first five cases. Main outcome measures were anatomic results as determined by optical coherence tomography and postoperative best-corrected visual acuity (BCVA).

RESULTS

Before surgery, a macular detachment was present in 10 eyes and a lamellar hole of the outer retina was detected in 9 eyes. Intraoperatively, two iatrogenic paramacular holes developed in two patients during posterior hyaloid dissection. Time to PVD induction appeared to be greatly reduced in the three patients injected with ocriplasmin before surgery. Patients were followed up for a mean of 38 months (range, 18-84) after surgery. Postoperatively, one patient (9%) developed a retinal detachment that was repaired with one additional vitrectomy. Complete resolution of fluid in and under the fovea was achieved in 8 of the remaining 10 eyes (80%) without additional treatment. Reduction of the inner retinal fluid always preceded the decrease of outer retinal fluid, which in turn anticipated the absorption of macular detachment. The macular detachment resolved in a mean of 14 months after surgery. Postoperative BCVA (mean, 0.63) improved significantly compared with preoperative BCVA (mean, 0.27) (P = 0.005). Nine eyes (82%) had a postoperative BCVA of 0.5 or better.

CONCLUSION

Vitrectomy with induction of PVD is a safe and successful therapeutic option for the treatment of optic disc pit maculopathy. The adjunct of ocriplasmin might facilitate the induction of PVD and reduce the risk of iatrogenic retinal holes.

Levels of beta-trace protein in optic disc pit with macular detachment

Background

To report beta‐trace protein (βTP) levels in the subretinal fluid (SRF) of four patients with a macular detachment associated with optic disc pit (ODP).

Methods

Four patients with a serous retinal detachment involving the macula was operated by pars plana vitrectomy (PPV) with C₂F₆ gas tamponade and peeling of internal limiting membrane (ILM). Patients with a follow‐up period exceeding one year postoperatively were included in the study. The SRF was drained using a fine cannula without laser photocoagulation, and the samples were analysed using particle‐enhancing nephelometry. The levels of βTP were compared to 20 routine cerebrospinal fluid (CSF) samples.

Results

In four of the five samples from SRF had relatively low βTP levels, with a mean concentration of 6.6 mg/l (range 2.0 to 23.1 mg/l) compared to 16.0 mg/l (range 6.3‐26.8 mg/l) in CSF. The only SRF sample within the range corresponding to normal CSF was the first sample from patient 4, and the analysis of the renewed aspirate during the second operation was 2.8 mg/l. Postoperatively, the regression of SRF was slow, but regression of SRF in the foveal region took place in all cases; however, visual acuity (VA) was improved in only half of the patients.

Conclusion

The results from the analysed SRF regarding βTP concentration in these patients indicate that the SRF in ODP is not identical to CSF, as the concentrations of βTP differ.

Use of Evicel Fibrin Sealant in Optic Disc Pit-Associated Macular Detachment

Optic disc pit is a rare congenital anomaly of the optic nerve. Retinal detachment is a common complication with poor outcomes. Many surgical alternatives have been described for the treatment of this condition, producing variable results. Herein, the authors describe four cases of optic disc pit-associated macular detachment managed with pars plana vitrectomy, fluid-air exchange, drainage of subretinal fluid through the optic disc pit, temporal peripapillary laser, and application of Evicel fibrin sealant (human) (Ethicon, Bridgewater, NJ) over the optic disc head. Case 1 showed stable visual acuity and improvement of subretinal fluid. Cases 2 and 3 showed visual acuity and subretinal fluid improvements. At the 1-week follow-up visit, Case 4 showed almost total subretinal fluid absorption. The sealant invariably disappeared between 1 and 2 weeks and was tolerated by all patients. This case series suggests that Evicel fibrin sealant may be considered as an adjunctive option in the surgical treatment of optic disc pit-associated maculopathy. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:358-363.].

A NEW TECHNIQUE WITH AUTOLOGOUS FIBRIN FOR THE TREATMENT OF PERSISTENT OPTIC PIT MACULOPATHY

PURPOSE

To report the use of autologous fibrin for the treatment of persistent optic pit maculopathy.

METHODS

The authors report two patients with an optic pit-related serous macular detachment, which persisted after vitrectomy and internal limiting membrane peeling. Autologous fibrin was prepared from the patients' whole blood and injected over the optic disk pit area to seal the pit/coloboma area followed by fluid-air-gas exchange.

RESULTS

Retina stayed attached starting from the first postoperative visit till the last visit at 27 (Case 1) and 14 (Case 2) months after surgery.

CONCLUSION

The use of autologous fibrin for the treatment of optic disk pit-related serous macular detachment seems a worthy contribution to the treatment of persistent cases.

[Maculopathy with optic nerve pits : Morphological criteria in SD-OCT]

PURPOSE

Optic pit is a congenital anomaly with malformation similar to coloboma of the optic disc. The cause of optic pit maculopathy is controversial. We used high resolution OCT to investigate changes in the vitreoretinal and vitreopapillary transition within optic pit eyes.

METHODS

The vitreoretinal and vitreo-papillary transition of 12 eyes was accurately analyzed using SD-OCT. We registered the following criteria: liquefaction of prepapillary vitreous, papillary vitreous traction, discontinuity within the hyaloid cortex and communication spaces between pit and retinal edema.

RESULTS

Communication gaps between pit and retinal edema were identified in 8 eyes. 4 eyes had a papillary vitreous traction. 4 showed a discontinuity in the hyaloid cortex. 2 of the 12 patients showed no maculopathy in SD-OCT. Those patients had an adjacent papillary vitreous without prepapillary liquefaction. However all eyes showed vitreous liquefaction at some stage premacullary or prepapillary.

CONCLUSION

Yet the cause of optic pit maculopathy is not clearly understood. High resolution OCT imaging provides a very detailed assessment of the vitreoretinal transition prepapillary and premacullary, however with limited penetration depth and analyzation of deeper lying structures. Our observations suggest that prepapillary liquefaction and pressure gradients within cerebrospinal and intraokular pressure could be key factors.

Formation of an Intraretinal Fluid Barrier in Cavitary Optic Disc Maculopathy

PURPOSE

Cavitary optic disc maculopathy develops when fluctuating pressure gradients along anomalous communications in the optic nerve head induce migration of fluid into the adjacent retinal tissue. We sought to determine whether carefully titrated laser photocoagulation combined with vitrectomy and gas tamponade can safely create an effective intraretinal barrier to fluid egress from the optic disc cavitation.

DESIGN

Retrospective interventional case series.

METHODS

We retrospectively evaluated medical records and imaging studies of 22 consecutive patients with cavitary disc maculopathy evaluated by a single surgeon between 1991 and 2014. Patients requiring surgery underwent carefully titrated juxtapapillary laser photocoagulation followed immediately by vitrectomy and gas tamponade. Main outcome measures were change in visual acuity, macular fluid resolution, and recurrence of maculopathy.

RESULTS

Eleven patients (11 eyes) had undergone vitreous surgery and were included in the study. No preoperative evidence for vitreous traction on the optic disc or macula was seen in any eye. Nine patients underwent a single surgery and 2 patients required additional procedures to resolve the macular fluid. Mean length of follow-up after the last surgery was 48.2 months (range, 4-143 months). All 11 patients (100%) had complete resolution of macular fluid, with an average time to resolution of 8.5 months (range, 1-18 months). Only 1 of 11 patients (9%) had recurrence of macular fluid (14 months postoperatively). The average preoperative visual acuity of 20/125 (logMAR 0.81, standard deviation [SD] = 0.36) improved by nearly 4 lines to an average final visual acuity of 20/57 (logMAR 0.45, SD = 0.37) (P = .0072). A possible laser-induced central scotoma was suspected in only 1 patient who had undergone extensive prior laser treatments.

CONCLUSIONS

An effective intraretinal barrier to fluid migration from cavitary optic disc anomalies can be safely achieved in most patients with carefully titrated juxtapapillary laser photocoagulation combined with vitrectomy and gas tamponade. Once achieved, the barrier facilitates resolution of macular fluid and long-term avoidance of recurrent maculopathy.

Vitrectomy for bilateral macular schisis without apparent optic disc anomalies

A 78-year-old man complained of bilateral visual acuity loss. Optical coherence tomography examination showed bilateral macular schisis with fluid accumulation in the external retinal layers without vitreous traction. Fundus examination and fluorescein angiography were normal in both eyes. Both eyes were treated by phacoemulsification, intraocular lens implantation, and vitrectomy without laser, gas exchange, or retinal fenestration. Slow and progressive fluid resorption and improvement in VA were observed in both eyes.

Macular schisis similar to the one associated with optic disc anomalies is a possibility in patients without apparent disc anomalies. Vitrectomy without laser, gas, or retinal fenestration may be a good therapeutic option even in patients with a PVD preoperatively.

LONG-TERM OUTCOMES OF RADIAL OPTIC NEUROTOMY FOR MANAGEMENT OF OPTIC DISK PIT MACULOPATHY

PURPOSE

To evaluate the long-term outcomes of radial optic neurotomy (RON) in patients with optic disk pit maculopathy and to compare the functional and anatomical outcomes of pars plana vitrectomy (PPV) with temporal side single RON versus PPV without RON.

METHODS

This retrospective study included 15 eyes of 15 consecutive patients who had surgery for optic disk pit maculopathy. Patients were followed for 12 to 115 months after surgery. Anatomical and functional results were evaluated with optical coherence tomography, MP-1 microperimetry in the central 20°, and measurement of best-corrected visual acuity. Descriptive statistical methods, Friedman chi-square test, post hoc Dunn test, Mann-Whitney test, Wilcoxon signed-rank test, and Fisher's exact test were used to determine the best-corrected visual acuity and MP-1 microperimetry differences between time points and to compare the results between the two treatment groups.

RESULTS

Two male and 5 female patients with a mean age 23.3 ± 8.7 (±standard error) years at presentation had PPV and silicone oil or gas tamponade with RON. Best-corrected visual acuity did not deteriorate after the operation in any of the eyes, and improved in 6 (86%) eyes (3 ± 2 lines). After surgery, complete resolution of fluid in the central macula was observed in 6 (86%) eyes. Five male and 3 female patients with a mean age 28.2 ± 8.2 years at presentation had PPV, posterior vitreous detachment, with or without juxtapapillary laser treatment, and silicone oil or gas tamponade. Best-corrected visual acuity did not deteriorate after the operation in any of the eyes, and improved in 5 (62.5%) eyes (2 ± 0.7 lines). After surgery, fluid in the central macula resolved completely in 4 (50%) eyes.

CONCLUSION

Pars plana vitrectomy with temporal side, single RON seems to be an effective method of managing optic disk pit maculopathy. The anatomical and functional improvements, without additional treatment or complication during the follow-up period, indicate that RON might be an alternative treatment approach to PPV alone for optic disk pit maculopathy.

[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.

Long-Term Changes of Macular Thickness after Pars Plana Vitrectomy in Optic Disc Pit Maculopathy: A Spectral-Domain Optical Coherence Tomography Study

PURPOSE

To evaluate macular thickness (MT) changes, using spectral domain optical coherence tomography (SD-OCT) in patients with optic disc pit (ODP) maculopathy after pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling.

PROCEDURES

Our retrospective study included nine patients with ODP maculopathy, treated with either PPV (n = 5) or PPV with ILM peeling (n = 4). All participants, who had a mean long-term follow-up of 33.4 ± 7.0 months, underwent a complete ophthalmological examination and SD-OCT. Due to the preoperative macular elevation, the postoperative MT in the operated patients was compared with that of fellow eyes and with normative data.

RESULTS

A significant reduction in MT was noticed in all macular sectors of the operated cases at the last examination. The reduction was more evident in the group of PPV with ILM peeling. At the last examination of the follow-up, there was a statistically significant improvement regarding BCVA in both groups in comparison with baseline, while the two groups did not differ significantly in between (p = 0.245).

CONCLUSIONS

In the long-term follow-up period, our study demonstrated a significant reduction in MT in patients with ODP maculopathy treated with PPV, which was more profound in those cases where PPV included ILM peeling. .

Optic disc pit maculopathy: when and how to treat? A review of the pathogenesis and treatment options

Optic disc pit (ODP) is a rare congenital anomaly of the optic disc, which can be complicated by a maculopathy associated with progressive visual loss. Optic disc pits are usually unilateral and sporadic in occurrence, and the development of maculopathy is unpredictable with no known triggers. Optic disc pit maculopathy (ODP-M) is characterized by intraretinal and subretinal fluid at the macula, causing visual deterioration. The source of this fluid is still unclear, and several competing theories have suggested it may be vitreous fluid, cerebrospinal fluid, leakage from blood vessels at the base of the pit or leakage from the choroid. The mechanism of pathogenesis of ODP-M has not been fully elucidated, but vitreous liquefaction and traction and pressure gradients within the eye have been implicated to be involved. There are no clear guidelines on the management of patients with ODP-M, and numerous techniques have been described, including laser photocoagulation, intravitreal gas injection, macular buckling and pars plana vitrectomy with many different modifications. The majority of reports describe small series, and as there are no comparative studies there is no consensus regarding the optimal treatment for ODP-M. This review discusses the literature on the possible sources of fluid and mechanisms of pathogenesis in ODP-M, as well as the wide array of treatment modalities and their results. Based on these, a set of recommended key concepts for the timing and choice of treatment for these challenging are presented.

Macular Buckling in Optic Disc Pit Maculopathy in Association with the Origin of Macular Elevation: 13-Year Mean Postoperative Results

Purpose

To discuss the anatomical and functional results in cases of optic disc pit maculopathy (ODP-M) with a follow-up of at least 11 years after scleral buckling procedure (SBP).

Methods

We studied 12 eyes with ODP-M treated with SBP, in a long-term follow-up of 12.8 ± 1.5 years after surgery. All patients underwent best-corrected visual acuity (BCVA) measurement, slit-lamp biomicroscopy, fundus photography, fluorescein angiography, indocyanine green angiography, B-scan ultrasonography, and optical coherence tomography at baseline and 6-12 months, 2 years and at least 11 years postoperatively.

Results

Complete macular reattachment was noticed between 6 and 12 months postoperatively. The BCVA improved significantly at the first postoperative examination. Further improvement was noticed at the second examination, while BCVA remained almost stable at the last examination. Foveal restoration of ellipsoid layer (inner segment/outer segment) was noted in 10 out of 12 cases. The existing vitreous strands remained unchanged during the follow-up. Vitreous traction gradually disappeared (4/5 eyes). Circulation in short/long posterior ciliary arteries was unaffected, while neither recurrences nor complications were observed during the follow-up period. Association of the scleral sponge to the scleral sheath of the optic nerve remained unchanged during the follow-up.

Conclusions

A total of 12.8 ± 1.5 years after treatment, all the studied cases retained the successful anatomical and functional results that they had 2 years postoperatively, without inducing cataract during the follow-up period. The SBP seems to act equally well as a barrier either obstructing the entrance of fluid from the vitreous cavity or blocking the circulation of subarachnoid cerebrospinal fluid into the retina.