EXTENT AND LOCATION OF INTRARETINAL AND SUBRETINAL FLUID AS PROGNOSTIC FACTORS FOR THE OUTCOME OF PATIENTS WITH OPTIC DISK PIT MACULOPATHY

Changes in Outcomes of Macular Optical Coherence Tomography Angiography Following Surgery for Optic Disc Pit Maculopathy

PURPOSE

we aimed to report on the optical coherence tomography angiography (OCTA) outcomes of eight patients with optic disc pit maculopathy (ODP-M) who were treated with 23-gauge pars plana vitrectomy (PPV).

METHODS

We examined sixteen eyes of eight patients-eight eyes with ODP-M and eight healthy fellow eyes. Fundus color photography, fundus autofluorescence, fundus fluorescein angiography, optical coherence tomography (OCT), and OCTA were performed. The vascular density, choriocapillaris blood flow (CCBF), and foveal avascular zone (FAZ) were analyzed using OCTA. Moreover, the correlation between the best-corrected visual acuity (BCVA) and macular OCTA parameters was assessed.

RESULTS

Compared with the healthy fellow eyes, the eyes with ODP-M preoperatively were found to have decreased BCVA, superficial capillary plexus (SCP) vascular density (i.e., total, foveal, parafoveal, and perifoveal), deep capillary plexus (DCP) vascular density (i.e., total, parafoveal, and perifoveal), and CCBF but a significantly increased FAZ (p < 0.05). When the eyes with ODP-M were analyzed pre- and postoperatively at month 12 after surgery, the BCVA, SCP vascular density (i.e., perifoveal), and CCBF had significantly increased, and the FAZ had significantly decreased (p < 0.05). When the eyes with ODP-M were compared with the healthy fellow eyes postoperatively at month 12, the BCVA, SCP, and DCP vascular density parameters had increased, along with CCBF, and the FAZ had decreased in eyes with ODP-M, though not to the levels of the healthy fellow eyes (p < 0.05). Moreover, a positive correlation was found between the postoperative BCVA and SCP total vascular density (p < 0.05).

CONCLUSION

The BCVA and macular OCTA parameters improved in eyes with ODP-M at month 12 following surgery. However, the BCVA and OCTA of the eyes operated on did not reach the levels of the healthy fellow eyes, possibly due to impaired choroidal blood flow (CBF) recovery and the presence of a larger FAZ. In summary, OCTA seems to be useful for assessing qualitative and quantitative perioperative microvascular changes.

OPTIC DISK PIT ASSOCIATED WITH AN UNUSUAL OUTER RETINAL HOLE AND NASAL PERIPHERAL RETINOSCHISIS

PURPOSE

To document a peculiar case of optic disk pit-associated maculopathy with extensive nasal retinoschisis with lamellar outer retinal hole.

METHODS

A 41-year-old woman presented to the eye clinic complaining of new photopsias and enlargement of the blind spot in the left eye. Uncorrected visual acuity was 20/20 in both eyes. Fundus examination of the left eye revealed an anomalous appearing optic nerve with a gray oval depression at the temporal margin of the disk consistent with an optic disk pit.

RESULTS

Optical coherence tomography confirmed the presence of the pit and demonstrated outer plexiform layer schisis superonasal to the fovea and extensive inner and outer retinal schisis nasal to the nerve extending to the equator. A large lamellar outer retinal hole was noted nasal to the disk without associated retinal detachment. The vitreous appeared to be attached over the nasal retina.

CONCLUSION

Multimodal imaging revealed an unusual optic disk pit-associated retinopathy with dramatically more extensive retinoschisis and a lamellar outer retinal hole nasal to the nerve despite the temporal location of the pit. Although the precise pathophysiologic mechanisms are not fully understood, forces associated with the vitreo-retinal adhesion may have contributed to the distribution of the schisis in this case.

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.

Treatment outcomes of optic disc pit maculopathy over two decades

Aim

To study the long-term outcomes of optic disc pit maculopathy.

Methods

Electronic medical records of 154 patients with optic disc pit were reviewed and 50 patients with optic disc pit maculopathy who met the study criteria were included in the study. Demographic profile of patients, along with clinical characteristics, optical coherence tomography (OCT) features and change in best-corrected visual acuity (BCVA) was recorded. Patients were treated either by observation, barrage laser alone or pars plana vitrectomy (PPV) with optional additional surgical procedures. The primary outcome measures were the change in BCVA and resolution of fluid on OCT.

Results

The mean age of patients was 29.96 years (3-62 years) with a follow-up of 27.16 months. The mean baseline BCVA in observation, laser and vitrectomy group was log MAR 0.94, 0.76 and 0.87 and final BCVA was log MAR 0.9, 0.67 and 0.46, respectively. There was a statistically significant improvement in the final BCVA and reduction in subretinal fluid with resolution of the schisis cavity in vitrectomy group than in other groups. On regression analysis significant association was found between final BCVA with baseline BCVA (R ² = 0.815, p = 0.002), use of C3 F8 endotempanode (p = 0.004) ILM peeling (p = 0.012) and use of triamcinolone (TA; p = 0.003). No significant association was found with juxtapapillary endolaser (p = 0.062).

Conclusions

In patients with disc pit maculopathy, PPV lead to better functional and anatomical outcomes as compared to laser or observation alone. Use of surgical adjuvants like ILM peeling, TA and C3F8 tamponade improved the outcomes, unlike juxtapapillary endolaser treatment.

A Case of Multiple Optic Disc Pits: 21-Year Follow-up

Optic disc pits (ODP) are an uncommon congenital abnormality. Patients remain asymptomatic unless they develop maculopathy. The use of optic coherence tomography has critical benefits in the follow-up of patients who are at the amblyogenic age. The aim of this study is to present a case of double ODP in the right eye and single ODP in the left eye in a partially accommodative esotropia patient followed for 21 years. To our knowledge, multiple ODP has never been described in a patient with partially accommodative esotropia.

Optic Disc Pit Maculopathy: One-Year Outcomes of Pars Plana Vitrectomy with Foveal Sparing Inverted Internal Limiting Membrane Flap

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.

Surgical outcomes in patients with optic disc pit maculopathy: does peeling the ILM lead to better outcomes?

PURPOSE

Optic disc pits (ODPs) are rare congenital anomalies. Several patients develop optic disc pit maculopathy (ODP-M): visual impairment caused by intra- and/or subretinal fluid. Treatment mode remains controversial. This study was designed to investigate the effectiveness of pars plana vitrectomy (PPV) and gas tamponade with or without internal limiting membrane (ILM)-peeling in improving visual acuity and reducing subretinal fluid in ODP-M patients.

METHODS

We retrospectively reviewed the charts of 16 patients who underwent surgery for ODP-M from 2002-2015. Six patients underwent PPV with gas tamponade (group 1); ten patients additionally received ILM-peeling (group 2). Pre- and postoperative visual acuity and central retinal thickness (CRT) were compared between groups, as well as retinal morphology and the number of secondary vitrectomies and complications.

RESULTS

Median visual acuity improved by 2 ETDRS lines in both groups (p = 0.713, Mann-Whitney U test). Median CRT decreased by 426.5 µm and 460 µm (p = 0.931). One patient in group 1 underwent repeat vitrectomy for persistent retinoschisis. Three patients in group 2 required repeat vitrectomy: two to treat a macular hole, one for peripheral retinal holes with retinal detachment.

CONCLUSION

In our cohort, PPV with gas tamponade proved to be an effective first-line treatment for ODP-M. Additional ILM-peeling did not give a significant benefit in this study.

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.

[Macular changes in optic disc pits-Optic disc pit maculopathy (ODP-M) : Pathophysiology and possibilities of surgical treatment]

An optic disc pit is a rare congenital abnormality of the optic nerve, which in most cases presents as a unilateral finding. Clinically, a greyish oval excavation is seen, most commonly on the temporal side of the optic nerve disc. The optic disc pit alone normally does not lead to substantial symptoms or functional limitations; however, when a maculopathy with intraretinal and/or subretinal fluid and additional other morphological changes in the macula occur, this leads to a decrease in visual acuity. With spectral domain optical coherence tomography (SDOCT) it is possible to identify the various forms of expression, which show different natural courses. Especially the presence of subretinal fluid and defects in the outer retinal layers have a poor prognosis and have the highest risk for further deterioration. Spontaneous resolution can occur but is rare. Observation is recommended in the first step. In cases of progression or pronounced deterioration, surgical intervention is indicated. Many different techniques have been proposed but there is no gold standard at the moment. Most of the surgical approaches comprise pars plana vitrectomy with peeling of the internal limiting membrane (ILM) and gas endotamponade. Newer methods, such as the ILM flap technique also show good results. Generally, it is important to know that postoperative healing and resorption of the fluid often take a long time period of up to 1 year or even longer.

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.

Incidence and Evolution of Subretinal Precipitates in Optic Disc Pit Maculopathy

PURPOSE

To study the evolution of subretinal precipitates coexistent with optic disc pit (ODP) maculopathy from their appearance at baseline examination until their absorption after successful treatment.

METHODS

Participants in this retrospective, multicenter study were 42 patients with ODP maculopathy, in whom complete ocular examination was performed, including visual acuity (VA) measurement, slit-lamp examination, color or red-free fundus photography, and optical coherence tomography at baseline after surgical treatment.

RESULTS

Out of 42 cases, 17 (40.5%) cases of ODP maculopathy, which were examined between 2002 and 2015, were found to have subretinal precipitates associated with multilayer fluid accumulation at baseline. Precipitates were located at the outer part of the photoreceptor layer and remained for 3-6 months after successful treatment and absorption of subretinal fluid. The mean VA was 0.99 ± 0.21 logMAR at baseline and improved to 0.54 ± 0.25 logMAR at the final examination.

CONCLUSIONS

Macular precipitates in association with signs of disease chronicity, such as multilayer fluid accumulation, became evident at baseline examination. Precipitates' disappearance in 15 out of 17 cases coincided with the absorption of subretinal fluid. The relative low VA at baseline probably could be attributed to the chronicity of the disease.

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.

Multicenter study of pars plana vitrectomy for optic disc pit maculopathy: MACPIT study

PurposeTo evaluate surgical intervention with pars plana vitrectomy (PPV) for correction of optic disc pit maculopathy (ODP-M).Patients and methodsRetrospective chart review from 13 centres of 51 eyes of 50 patients with ODP-M who underwent PPV between 2002-2014. Anatomic and final best-corrected visual acuity (BCVA) outcomes were evaluated for all cases with different adjuvant techniques.ResultsThere were 23 males and 27 females with median age 25.5 (6-68) years. Preoperative median foveal thickness was 694.5 (331-1384) μm and improved to 252.5 (153-1405) μm. Median BCVA improved from 20/200 (20/20000 to 20/40) to 20/40 (20/2000 to 20/20) with 20/40 or better in 31 eyes. Complete retinal reattachment was achieved in 44 eyes (86.3%) at 7.1 (5.9) months. The good surgical outcomes were achieved in different adjuvant groups. Median follow-up was 24 (6 to 120) months.ConclusionsThese results confirm the long-term effectiveness of PPV for ODP-M. Prospective studies are needed to determine the effectiveness of any adjuvant technique in improving the success of PPV for ODP-M.