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Boscia G, Sborgia G, Niro A, Dore S, Landini L, Scotti G, Boscia F. Management of unresolved optic disc pit maculopathy with human amniotic membrane patch implant: A case report. Eur J Ophthalmol 2023; 33:NP128-NP132. [PMID: 36823771 DOI: 10.1177/11206721231159692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND/PURPOSE Inverted Inner Limiting Membrane (ILM)-flap approach can fail in the treatment of Optic disc pit maculopathy (ODPM). We report a surgical technique involving human amniotic membrane (hAM) patch implant to treat unresolved ODPM after inverted (ILM)-flap technique. CASE REPORT One patient with decreased visual acuity (1 LogMar) after unsuccessful inverted ILM-flap technique to treat ODPM, underwent hAM patch implant and was evaluated. A surgical approach including a 2 mm size graft patch of hAM implantation over the optic disc pit followed by fluid-air exchange was performed. A gas endotamponade was finally used. The patient was instructed to maintain face-down position for the first three days after surgery. The hAM patch remained detectable over the pit for the entire 6-months follow-up. The ODPM gradually resolved and visual acuity partially recovered to 0.17 LogMar during follow-up. No postoperative complications or recurrence were reported. CONCLUSION hAM patch implant may be effective to manage ODPM after unsuccessful inverted ILM-flap.
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Affiliation(s)
- Giacomo Boscia
- Eye Clinic Section, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Giancarlo Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "SS. Annunziata", ASL Taranto, Taranto, Italy
| | - Stefano Dore
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luca Landini
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Giacomo Scotti
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Francesco Boscia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
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Shen J, Chen X, Gong X, Wu Z. Internal limiting membrane packing for treatment of morning glory syndrome with rhegmatogenous retinal detachment. Am J Ophthalmol Case Rep 2022; 26:101454. [PMID: 35265775 PMCID: PMC8899239 DOI: 10.1016/j.ajoc.2022.101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Observations Conclusions and importance Morning Glory syndrome (MGS) is a rare congenital optic disc abnormality. We report a case of MGS combined with rhegmatogenous retinal detachment (RRD) in which the contractile movement of the retinal hole was observed. This case is the first to report the successful treatment of a retinal hole in a MGS patient by internal limiting membrane tamponade combined with autologous blood coverage.
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Caporossi T, D'Amico G, Tartaro R, Governatori L, Scampoli A, Amorelli G, De Vico U, Rizzo S. Optic Disk Pit Maculopathy Treatment Using a Human Amniotic Membrane Patch: One-Year Results. Am J Ophthalmol 2022; 240:30-36. [PMID: 35227693 DOI: 10.1016/j.ajo.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To report the 1-year results of human amniotic membrane patch implantation for optic disc pit maculopathy. DESIGN A prospective, consecutive, interventional study. METHODS Eleven eyes of 11 patients affected by optic disc pit maculopathy associated with subretinal/intraretinal fluid were included in this single-institution study. A 25-gauge pars plana vitrectomy was performed in all cases, with an implant of a human amniotic membrane patch into the optic disc pit and air was injected as endotamponade. The primary study outcome was the subretinal and intraretinal fluid reabsorption. Secondary outcomes were visual acuity improvement and postoperative complications. RESULTS Mean central retinal thickness gradually diminished from 512 ± 137 µm to 243 ± 19 µm, at the 12-month follow-up. The mean visual acuity improved from 20/80 at baseline to 20/32 at the 12-month follow-up. Complete fluid resorption occurred in 9 of 11 (81.8%) eyes and there was partial resorption in 2 eyes (18%). No subretinal fluid recurrence was observed during the 12-month follow-up. No intraoperative or postoperative complications were reported during the follow-ups. The amniotic membrane patch remained detectable inside the pit for the entire follow-up time. CONCLUSION An amniotic membrane plug may be effective for improving optic disc pit maculopathy. All cases had an anatomical improvement and encouraging visual acuity recovery.
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Affiliation(s)
- Tomaso Caporossi
- From Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome (T.C, G.D'A, A.S, G.A, U.DeV, S.R)
| | - Guglielmo D'Amico
- From Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome (T.C, G.D'A, A.S, G.A, U.DeV, S.R)
| | - Ruggero Tartaro
- Department of NEUROFARBA, Ophthalmology, University of Florence, Careggi, Florence, Italy (R.T, L.G).
| | - Lorenzo Governatori
- Department of NEUROFARBA, Ophthalmology, University of Florence, Careggi, Florence, Italy (R.T, L.G)
| | - Alessandra Scampoli
- From Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome (T.C, G.D'A, A.S, G.A, U.DeV, S.R)
| | - Giulia Amorelli
- From Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome (T.C, G.D'A, A.S, G.A, U.DeV, S.R)
| | - Umberto De Vico
- From Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome (T.C, G.D'A, A.S, G.A, U.DeV, S.R)
| | - Stanislao Rizzo
- From Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome (T.C, G.D'A, A.S, G.A, U.DeV, S.R)
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Iros M, Parolini B, Ozdek S, Gini G, Nawrocka ZA, Ellabban AA, Faramawi MF, Adelman R, Sallam AB, Meireles A, Lee CS, Ducournau D, Tsouris D, Kozina E, Patelli F, Viola F, Ascaso F, Becquet F, Tosi GM, Besozzi G, Oh H, Othman IS, Fiser I, Le Rouic J, Perone J, Amar J, Nawrocki J, Nascimento J, Arrevola L, Nagpal M, Mehrotra N, Demir M, Chelazzi P, Miesbauer P, Turkcuoglu P, Koch P, Uy R, Weinfurter SB, Bopp S, Park S, Schönherr U, Alsanova V, Bonfiglio V, Szijárt Z. Management of optic disc pit maculopathy: the European VitreoRetinal society optic pit study. Acta Ophthalmol 2021; 100:e1264-e1271. [PMID: 34877796 DOI: 10.1111/aos.15076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/26/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate a variety of techniques, and their anatomical and functional results, for the treatment of optic disc pit maculopathy (ODP-M). A secondary aim was to report on results of secondary procedures in cases of initial failure or recurrence. METHODS Multicentre retrospective study of 95 eyes with ODP-M, treated by 25 surgeons from 12 countries. Primary outcomes were anatomical resolution of subretinal fluid (SRF), intraretinal fluid (IRF) and visual acuity (VA) at 12 months. RESULTS Higher rates of SRF and IRF resorption were achieved in eyes treated with pars plana vitrectomy (PPV) compared to external laser with or without tamponade: 64/72 (88.9%) versus 8/14 (57.1%) for SRF (p = 0.003), and 50/59 (84.7%) versus 3/10 (30%) for IRF (p = 0.002). The addition of juxtapapillary laser or internal limiting membrane (ILM) peel during PPV did not improve SRF or IRF resolution. Pars plana vitrectomy (PPV) with tamponade and PPV with tamponade plus endolaser were associated with significant visual gain. In the former group, VA improved from a mean of logMAR 0.91 (20/162), to a mean of logMAR 0.52 (20/66) at 12 months; in the latter group, VA improved from a mean of logMAR 0.82 (20/132) to a mean of logMAR 0.47 (20/59) at 12 months. Retreatments were performed in 14 eyes (15.7%), only enhancing anatomical outcomes. CONCLUSION Vitrectomy with tamponade had better final outcomes than external laser treatment with or without gas tamponade. Laser endophotocoagulation and ILM peel provided no additional benefit. A secondary treatment resulted in anatomical but not functional improvement.
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Affiliation(s)
- Mariano Iros
- Instituto de Microcirugía Ocular Córdoba Córdoba Argentina
| | | | - Sengul Ozdek
- Department of Ophthalmology Faculty of Medicine Gazi University Ankara Turkey
| | - Giampaolo Gini
- Western Sussex NHS Trust and Nuffield Haywards Heath Hospital Sussex UK
| | | | - Abdallah A Ellabban
- Hull University Teaching Hospitals Hull UK
- Department of Ophthalmology Suez Canal University Ismailia Egypt
| | - Mohammed F. Faramawi
- Departments of Bioinformatics and Epidemiology University of Arkansas for Medical Sciences Little Rock AR USA
| | - Ron Adelman
- Department of Ophthalmology Yale University New Haven CT USA
| | - Ahmed B. Sallam
- Jones Eye Institute University of Arkansas for Medical Sciences Little Rock AR USA
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Meng L, Zhao X, Zhang W, Wang D, Chen Y. The characteristics of optic disc pit maculopathy and the efficacy of vitrectomy: a systematic review and meta-analysis. Acta Ophthalmol 2021; 99:e1176-e1189. [PMID: 33421324 DOI: 10.1111/aos.14730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Lihui Meng
- Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Xinyu Zhao
- Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Wenfei Zhang
- Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Dongyue Wang
- Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Youxin Chen
- Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
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Muftuoglu IK, Tokuc EO, Karabas VL. Management of optic disc pit-associated maculopathy: A case series from a tertiary referral center. Eur J Ophthalmol 2021; 32:1720-1727. [PMID: 34132128 DOI: 10.1177/11206721211023727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report outcomes of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) stuffing technique in patients with optic disc pit associated maculopathy (ODP-M). METHODS Data including best-corrected visual acuity (BCVA), central macular thickness (CMT), foveal center point thickness (FCP), and maximum height of fluid (max_fluid) (intraretinal or subretinal) were collected from the medical records of the patients. RESULTS Six eyes of six patients with a mean age of 28.0 ± 17.68 years (range: 9-53 year) underwent PPV + ILM plug surgery. The mean follow-up duration was 25.62 ± 26.11 months (range: 11.80-78.00 month) duration. The mean BCVA increased from 1.25 ± 1.04 logMAR (20/355, Snellen equivalent) to 0.86 ± 1.09 logMAR (20/144, Snellen equivalent) at last follow-up (p = 0.043). Compared to baseline, CMT, FCP, and max_fluid significantly decreased at all visits after the surgery (p < 0.05 for all visits). At last follow-up, 66.6% of the eyes (four eyes) showed complete resolution of fluid at a mean of 5.25 ± 4.99 months (range: 1-12 months) after the surgery. CONCLUSION PPV with ILM plug seemed to be an effective surgical technique in ODP-M. Studies with longer follow-up and higher number of patients are needed to confirm our results.
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Affiliation(s)
- Ilkay Kilic Muftuoglu
- Istanbul Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Ecem Onder Tokuc
- University of Health Sciences Derince Training and Research Hospital, Department of Ophthalmology, Kocaeli, Turkey
| | - V Levent Karabas
- Kocaeli University School of Medicine, Department of Ophthalmology, Kocaeli, Turkey
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Fernández-Engroba J, Saman M, Nadal J. Internal limiting membrane graft as a treatment for the retinal detachment secondary to an optic disc coloboma. Eur J Ophthalmol 2021; 31:2765-2768. [PMID: 33530723 DOI: 10.1177/1120672121992686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report our anatomical outcome with the internal limiting membrane (ILM) graft procedure in the management of rhegmatogenous retinal detachment (RRD) secondary to optic disc coloboma (ODC). METHODS Description of a new surgical procedure in one eye of one patient who underwent pars plana vitrectomy (PPV) combined with ILM graft technique. Subsequent follow-up included optical coherence tomography (OCT) and visual acuity. RESULTS After only 1 week, the OCT revealed the ILM graft plugging the retinal tear with complete resorption of subretinal fluid. The sealing effect of this graft persisted after 6 months. However, visual outcome was poor and corrected distance visual acuity was 20/200 as a result of the previous long-standing retinal detachment with loss of photoreceptors. CONCLUSION We suggest that ILM graft could be performed as a first line treatment in the management of RRD secondary to ODC. This direct closure of the retinal tears, allows a quick and effective interruption of the communication between the subretinal space and the vitreous cavity. Detecting these retinal tears and applying this technique as soon as possible could achieve not only an earlier anatomical success but obtain good visual results in retinal tears with RRD secondary to ODC. Further studies will be necessary to provide more evidences.
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Affiliation(s)
- Jorge Fernández-Engroba
- Centro de Oftalmologia Barraquer, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Muhsen Saman
- Centro de Oftalmologia Barraquer, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jeroni Nadal
- Centro de Oftalmologia Barraquer, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
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Torrado-Cobian LA, Fivgas GD. Optic nerve pit maculopathy worsened during pregnancy: a case report. BMC Ophthalmol 2021; 21:21. [PMID: 33413194 PMCID: PMC7791707 DOI: 10.1186/s12886-020-01775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report a case of Optic Disc Pit (ODP) maculopathy exacerbated during pregnancy. CASE PRESENTATION A 30-year-old female developed unilateral blurry vision at 10-weeks gestation. Ophthalmic examination revealed left eye reduced visual acuity (VA) with the presence of subretinal fluid temporal to the disc extending to the fovea. On Spectral Domain Optical Coherence Tomography (SD-OCT) subretinal, and intraretinal fluid was confirmed. Laser photocoagulation was tried in an attempt to prevent surgical intervention without success; subsequently, pars plana vitrectomy, internal limiting membrane peel and gas tamponade was performed. Three-weeks later, a full thickness macular hole developed, and repeat surgery was performed. Nine-months after the second surgery the macular hole was closed with near complete resorption of edema. CONCLUSIONS No trigger factors for ODP maculopathy have been reported before. We report a case of worsening ODP maculopathy during pregnancy with good visual outcome after surgical intervention.
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Affiliation(s)
- Laura A Torrado-Cobian
- Department of Ophthalmology, Retina Division, Louisiana State University (LSU) School of Medicine, 533 Bolivar Street, Room 451B, New Orleans, LA, 70112, USA
| | - George D Fivgas
- LSU Department of Ophthalmology, Retina Division, Private Practice: The Retina Center, 7777 Hennessy Blvd, Suite 3000, Baton Rouge, LA, 70808, USA.
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Makdoumi K, Crafoord S. A prospective long-term follow-up study of optic disc pit maculopathy treated with pars plana vitrectomy, drainage of subretinal fluid and peeling of internal limiting membrane. Acta Ophthalmol 2020; 98:822-827. [PMID: 32421253 DOI: 10.1111/aos.14475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the long-term results of surgical repair of patients with optic disc pit maculopathy (ODP-M). METHODS Prospective, consecutive, noncomparative follow-up study including 12 patients with ODP-M treated by pars plana vitrectomy (PPV), peeling of internal limiting membrane followed by gas tamponade. Subretinal fluid (SRF) was drained in 11 eyes through a retinotomy without laser photocoagulation. Preoperatively, macular detachment with retinoschisis was seen in 9 out of 12 eyes with three eyes having only subretinal fluid in the macular area. The median age at surgery was 20 years (range 9-60 years). RESULTS Follow-up time from initial surgery was 63 months (median). Eight eyes were anatomically reattached after one operation without remaining SRF in the macula. Two patients required a reoperation due to leakage from the retinotomy and another two underwent a second PPV procedure due to late recurrences. Successful healing was at follow-up control observed in 11 of 12 eyes. There was no statistically significant difference in visual acuity between patients before and after surgery (p = 0.24). Central visual field defects with depressed mean deviation were detected in all treated eyes. CONCLUSION In this long-term study of ODP-M final outcome regarding healing was relatively efficacious, however, a relatively large proportion had complications associated to retinotomies. We conclude that drainage of SRF should likely be avoided since it appears to contribute little to the resorption rate of SRF and seems to linked to unnecessary risks.
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Affiliation(s)
- Karim Makdoumi
- Department of Ophthalmology Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Sven Crafoord
- Department of Ophthalmology Faculty of Medicine and Health Örebro University Örebro Sweden
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Total retinal detachment and contractile movement of the disc in eyes with morning glory syndrome. Am J Ophthalmol Case Rep 2020; 20:100964. [PMID: 33117915 PMCID: PMC7581832 DOI: 10.1016/j.ajoc.2020.100964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/15/2020] [Accepted: 10/04/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose This study aimed to report clinical characteristics, intraoperative findings, and surgical outcomes of 2 eyes of 2 patients with retinal detachment (RD) associated with morning glory syndrome (MGS) and contractile movement of the disc. Observations Case 1 was a 3-year-old Japanese boy who presented with congenital microphthalmos in the left eye. The presence of total RD with MGS and contractile movement of the disc was confirmed by ophthalmoscopic examination. During vitrectomy, migration of perfluorocarbon liquid into the subretinal space was observed, suggesting a communication between the vitreous cavity and the subretinal space. Here, the retina was reattached briefly after the surgery; however, it detached again 2 months after surgery. Case 2 was a 3-month-old Japanese girl who was referred to our hospital for evaluation of RD and MGS in her left eye. Partial RD, MGS, and contractile movement of the disc were confirmed by ophthalmoscopic examination. The RD remained unchanged up to 18 months from the first visit, but atresia of the pupil was found 21 months after the first visit. Severe proliferative vitreoretinopathy and contractile movement of the disc were found after lensectomy. It was impossible to completely remove the membrane despite meticulous effort of peeling it off. At the 15-month follow-up, the retinal configuration improved but remained detached. Conclusion and importance Total RD with contractile movement of the disc associated with MGS is a rare condition that seems difficult to treat.
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Surgical outcomes in patients with optic disc pit maculopathy: does peeling the ILM lead to better outcomes? Int Ophthalmol 2020; 40:3363-3376. [PMID: 32737732 PMCID: PMC8370961 DOI: 10.1007/s10792-020-01524-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 07/17/2020] [Indexed: 10/26/2022]
Abstract
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.
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Pastor-Idoate S, García-Arumí Fusté C, García-Onrubia L, Copete S, García-Arumí J. Surgical Options for Optic Disc Pit Maculopathy: Perspectives and Controversies. Clin Ophthalmol 2020; 14:1601-1608. [PMID: 32606575 PMCID: PMC7308761 DOI: 10.2147/opth.s250921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
Optic disc pit (ODP) is a rare congenital optic nerve head abnormality, which can be complicated by intraretinal and subretinal fluid at the macula (ODP-maculopathy) with progressive visual loss. The source of this fluid remains unclear and the most dominant hypotheses have pointed to vitreous cavity or cerebrospinal fluid. Although spontaneous resolution has been reported, the majority of untreated cases of ODP-maculopathy result in final visual acuity less than 20/200 or worse. A wide array of interventions, either individually or in combination with adjuvant treatments, have been tried with varying degrees of success. Recently, different surgical procedures to fill the ODP by self-sealing materials in combination with pars plana vitrectomy have been reported as an effective adjuvant treatment. However, given the relative rarity of this condition, the majority of reports describe a small retrospective case series, making it difficult to compare among different treatments options and create a consensus regarding the optimal treatment for ODP-maculopathy. In this situation, a mini-review about surgical treatment modalities and their results can be a useful approach to identify the most effective surgical option in the management of ODP-maculopathy.
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Affiliation(s)
- Salvador Pastor-Idoate
- IOBA Eye Institute, University of Valladolid, Valladolid, Spain.,Clinical University Hospital of Valladolid, Valladolid, Spain.,Red Temática de Investigación Cooperativa en Salud (RETICS), Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - Claudia García-Arumí Fusté
- Vall d´Hebron University Hospital, Barcelona, Spain.,Ophthalmology Research, Vall d´Hebron Research Institute (VHIR), Barcelona, Spain
| | | | | | - José García-Arumí
- Red Temática de Investigación Cooperativa en Salud (RETICS), Oftared, Instituto de Salud Carlos III, Madrid, Spain.,Vall d´Hebron University Hospital, Barcelona, Spain.,Ophthalmology Research, Vall d´Hebron Research Institute (VHIR), Barcelona, Spain.,Ocular Microsurgery Institute (IMO), Barcelona, Spain.,Department of Ophthalmology, Autonomous University of Barcelona, Barcelona, Spain
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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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