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Arturo C, Maurizio F, Grazia PM, Loredana A, Alessandro A, Roberta F. OCT-angiography in optic disk pit after inverted ILM flap: A case report. Eur J Ophthalmol 2024; 34:NP127-NP132. [PMID: 37264599 DOI: 10.1177/11206721231177894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND To describe OCT-angiography features in a case of an optic disk pit (ODP) which underwent a pars plana vitrectomy with inverted ILM flap for macular detachment. CASE PRESENTATION A 12 years old child with an ODP responsible for a macular detachment underwent 23G vitrectomy in the subacute phase of the disease with an inverted ILM flap used as a plug over the lateral dehiscence of the pit. Among the various retinal imaging examinations performed in the post-operative period, the OCT-angiography showed very interesting features characterized by a capillary drop-out in correspondence of the superficial and deep capillary plexus, a fine texture of the choroid capillary layer and star-shaped folds in correspondence of both the outer retina and the choroid capillary layer. OCT-A performed 24 months after surgery showed a normalization of the macular perfusion which correlated with a full recovery of the visual acuity of the young child. CONCLUSIONS OCT-A is an useful tool to monitor the subretinal fluid reabsorption after ILM inverted flap surgery for ODP-maculopathy and correlates with visual function. OCT-A may be useful in the follow-up of this rare condition as well as its response to therapeutic strategies.
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Affiliation(s)
- Carta Arturo
- Ophthalmology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Pertile Maria Grazia
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Appezzati Loredana
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Alfano Alessandro
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
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Optic Pit Maculopathy: Clinical Features and Management Options. CURRENT OPHTHALMOLOGY REPORTS 2022; 9:158-167. [PMID: 35178287 DOI: 10.1007/s40135-021-00274-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose of Review In this article, we review the pathogenesis, clinical features, imaging modalities and latest management options for optic pit maculopathy (OPM). Recent Findings The pathogenesis of OPM remains to be unclear, but imaging tools such as optical coherence tomography (OCT) and OCT angiography are enhancing our knowledge. Observation continues to be the best management strategy for patients with good visual acuity, and many cases have demonstrated spontaneous resolution. For more advanced, progressive vision loss, treatment options involving vitrectomy can be considered and discussed with the patient. Supplementary techniques to vitrectomy have been reported in small studies with relative success such as glial tissue peeling, inverted internal limiting membrane flap, optic pit plugging, and retinal fenestration. Summary While there are multiple treatment options available for OPM, there is no consensus on the technique and surgical timing. Individual patient factors and the risks-benefits of treatment must be taken into account in guiding management. Larger clinical trials will further assist in decision making for treating OPM.
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Lorusso M, Zito R, Micelli Ferrari L, Nikolopoulou E, Cicinelli MV, Borrelli E, Querques G, Micelli Ferrari T. Spontaneous resolution of optic pit maculopathy: an OCT report. Ther Adv Ophthalmol 2020; 12:2515841420950843. [PMID: 32923940 PMCID: PMC7453435 DOI: 10.1177/2515841420950843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/28/2020] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Massimo Lorusso
- Department of Ophthalmology, Ente Ecclesiastico Ospedale Generale Regionale 'F, Miulli', Bari, Italy
| | - Roberta Zito
- Department of Ophthalmology, Ente Ecclesiastico Ospedale Generale Regionale 'F, Miulli', Bari, Italy
| | - Luisa Micelli Ferrari
- Department of Ophthalmology, Ente Ecclesiastico Ospedale Generale Regionale 'F, Miulli', Bari, Italy
| | - Eleni Nikolopoulou
- Department of Ophthalmology, Ente Ecclesiastico Ospedale Generale Regionale 'F, Miulli', Bari, Italy
| | | | - Enrico Borrelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Tommaso Micelli Ferrari
- Department of Ophthalmology, Ente Ecclesiastico Ospedale Generale Regionale 'F, Miulli', Bari, Italy
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Lüke JN, Schaub F. [Partial retinal fenestration for optic disc pit maculopathy]. Ophthalmologe 2020; 117:939-944. [PMID: 32691162 DOI: 10.1007/s00347-020-01175-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- J N Lüke
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - F Schaub
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Theodossiadis G, Theodossiadis P, Chatziralli I. Thoughts and Challenges for the Current Treatment of Optic Disc Pit Maculopathy. Semin Ophthalmol 2020; 35:232-236. [PMID: 32809892 DOI: 10.1080/08820538.2020.1809684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- George Theodossiadis
- 2 Department of Ophthalmology, National and Kapodistrian University of Athens , Athens, Greece
| | | | - Irini Chatziralli
- 2 Department of Ophthalmology, National and Kapodistrian University of Athens , Athens, Greece
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Al-Moujahed A, Callaway NF, Vail D, Ludwig CA, Ji MH, Moshfeghi DM. Resolution of optic disc pit-associated macular retinoschisis after topical carbonic anhydrase inhibitor treatment: Report of a case. Eur J Ophthalmol 2020; 31:NP25-NP28. [PMID: 32019335 DOI: 10.1177/1120672120904664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Optic disc pits frequently lead to visual deterioration due to macular retinoschisis or serous retinal detachment. Here, we report a case of optic disc pit-associated macular retinoschisis due to intraretinal fluid accumulation that resolved with improvement in visual acuity after treatment with topical dorzolamide. CASE DESCRIPTION A 56-year-old otherwise healthy female with no ocular history presented with 2 weeks of slowly worsening blurry vision in her right eye. Visual acuity was 20/30 in the right eye. Posterior segment examination revealed posterior vitreous detachment, an optic disc pit at 9 o'clock, macular edema and foveoschisis with fluid extending from the optic nerve, and a normal peripheral retina. Optical coherence tomography imaging of the macula showed central subfield thickness of 526 µm. The patient preferred no surgical intervention, so topical dorzolamide 2% three times daily was initiated. Over the next 2 years, the central subfield thickness steadily declined from 526 to 262 µm, and her vision improved to 20/20 with improvement in the macular retinoschisis. CONCLUSION Our report presents a case of resolution of optic disc pit-associated macular retinoschisis due to intraretinal fluid accumulation with possible role for dorzolamide as a potential treatment option.
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Affiliation(s)
- Ahmad Al-Moujahed
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Natalia F Callaway
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Daniel Vail
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Cassie A Ludwig
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Marco H Ji
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Darius M Moshfeghi
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
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Optic Disc Pit Maculopathy: New Perspectives on the Natural History. Am J Ophthalmol 2019; 207:159-169. [PMID: 31095956 DOI: 10.1016/j.ajo.2019.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 12/11/2022]
Abstract
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.
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Chatziralli I, Theodossiadis P, Theodossiadis GP. Optic disk pit maculopathy: current management strategies. Clin Ophthalmol 2018; 12:1417-1422. [PMID: 30127591 PMCID: PMC6089607 DOI: 10.2147/opth.s153711] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, University of Athens, Attikon Hospital, Athens, Greece,
| | | | - George P Theodossiadis
- 2nd Department of Ophthalmology, University of Athens, Attikon Hospital, Athens, Greece,
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Shah PK, Karandikar SS, Narendran V. Scleral Autograft for Optic Nerve Head Pit Associated Chronic Maculopathy. Ophthalmic Surg Lasers Imaging Retina 2017; 48:251-254. [DOI: 10.3928/23258160-20170301-09] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/12/2017] [Indexed: 11/20/2022]
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10
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Chatziralli I, Theodossiadis P, Theodossiadis G. Current management of optic disc pit. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1224654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mishra A, Aggarwal S, Bhargava N, Baranwal VK. Unusual coexistence of bilateral optic disc pits with unilateral macular hole. Med J Armed Forces India 2016; 71:S514-6. [PMID: 26858486 DOI: 10.1016/j.mjafi.2014.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/19/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Avinash Mishra
- Classified Specialist (Ophthalmology), Military Hospital, Ahemdabad, India
| | - Somesh Aggarwal
- Associate Professor, M & J Western Regional Institute of Ophthalmology, Ahemdabad, India
| | - Neeraj Bhargava
- Senior Advisor (Ophthalmology), Command Hospital (Southern Command), Pune, India
| | - V K Baranwal
- Senior Advisor (Ophthalmology), Command Hospital (Northern Command), Udhampur, India
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Moisseiev E, Moisseiev J, Loewenstein A. Optic disc pit maculopathy: when and how to treat? A review of the pathogenesis and treatment options. Int J Retina Vitreous 2015; 1:13. [PMID: 27847606 PMCID: PMC5088488 DOI: 10.1186/s40942-015-0013-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 07/30/2015] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Elad Moisseiev
- grid.413449.f0000000105186922Department of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weitzman st., Tel Aviv, 64239 Israel ; grid.12136.370000000419370546Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; grid.413079.80000000097528549Department of Ophthalmology and Visual Science, UC Davis Medical Center, Sacramento, CA USA
| | - Joseph Moisseiev
- grid.413795.d0000000121072845Department of Ophthalmology, Sheba Medical Center, Ramat Gan, Israel ; grid.12136.370000000419370546Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- grid.413449.f0000000105186922Department of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weitzman st., Tel Aviv, 64239 Israel ; grid.12136.370000000419370546Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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