Vitrectomy for optic disc pit-associated maculopathy with or without preoperative posterior vitreous detachment

Resolution Pattern and Predictors of Outcome for Optic Disc Pit - Maculopathy Following Vitrectomy: An Optical Coherence Tomography Based Morphometric Analysis

BACKGROUND

To characterize the resolution pattern and macular structure recovery of optic disc pit-maculopathy (ODP-M) following vitrectomy using spectral domain-optical coherence tomography (SD-OCT).

METHODS

This is a single-center, retrospective, observational case series. Serial SD-OCT scans of all consecutive eyes of ODP-M undergoing vitrectomy were evaluated to analyze the sequence of maculopathy resolution.

RESULTS

Subretinal fluid (SRF) resolved/reduced in 9 of 12 eyes over a mean of 6 months. For eyes showing resolution, we observed that the closure of the communication tract (CT) [1-3 months] preceded the closure of outer layer defect (OLD) [2-6 months], while SRF[1-12 months] and outer retinal fluid(ORF)[1-12 months] were the last to be resolved. Three eyes with residual SRF/macular fluid had a patent CT.

CONCLUSION

Maculopathy resolved in a staged manner: closure of CT preceded the closure of OLD and absorption of SRF. Non-closure of CT was associated with the persistence of maculopathy.

SYNOPSIS

Optic disc pit maculopathy following vitrectomy shows a staged resolution. The persistence of maculopathy is seen in eyes with non-closure of the communication tract.

ABBREVIATION

Key CDVA: Corrected distance visual acuityCMT: Central macular thicknessCR: Complete restorationCT: Communication tractILM: Internal limiting membraneIRF: Inner retinal fluidIR: Incomplete restorationMLF: Multilayered fluidODP-M: Optic disc pit maculopathyOLD: Outer layer defectORF: Outer retinal fluidPPV: Pars plana vitrectomyPVD: Posterior vitreous detachmentSD-OCT: Spectral Domain-Optical Coherence TomographySRF: Subretinal fluid.

Papillomacular retinoschisis associated with glaucoma: Response to topical carbonic anhydrase inhibitor

Purpose

Observations

Conclusionsand Importance

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.

Anterior Lens Capsule Transplantation for Acquired Optic Disc Pit Maculopathy

A patient with acquired optic disc pit (ODP) maculopathy underwent vitrectomy with anterior capsule transplantation to the ODP and gas tamponade. Structural changes were evaluated by enhanced depth imaging optical coherence (OCT) tomography. During vitrectomy, the eye was confirmed to have preexisting posterior vitreous detachment. Postoperative OCT showed complete closure of the optic pit resulting in rapid absorption of subretinal fluid. The authors' observations suggest that the anterior capsule is a useful material for achieving optic pit closure. To the authors' knowledge, this is the first report describing application of the anterior capsule to the treatment of ODP maculopathy. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:649-652.].

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 MACULAR RETINOSCHISIS WITHOUT A DETECTABLE OPTIC DISK PIT

PURPOSE

To evaluate the efficacy of vitrectomy in the treatment of macular retinoschisis without a detectable optic disk pit.

METHODS

This retrospective interventional case series included eight patients with acquired, unilateral macular retinoschisis with or without foveal detachment. Patients with an optic disk pit, vitreomacular traction, or high myopia were excluded. Six of the eight patients underwent vitrectomy with internal limiting membrane peeling and fluid-air exchange. The surgical outcome was evaluated in terms of the improvement in the macular anatomy and the best-corrected visual acuity.

RESULTS

During vitrectomy, all the six eyes were confirmed to have preexisting posterior vitreous detachment. Macular retinoschisis was resolved or reduced in all the six eyes after vitrectomy. The mean central foveal thickness showed significant improvement at the time of the patient's final visit after vitrectomy. The mean best-corrected visual acuity was 20/52 before surgery and 20/31 at the final visit.

CONCLUSION

Vitrectomy might be effective for the treatment of macular retinoschisis without an optic disk pit. Although clinically similar to optic pit maculopathy except for the absence of pit, our intraoperative observations of the posterior hyaloid membrane suggest that maculopathy without optic disk pit has a distinct pathogenesis.

Peripapillary retinal splitting visualized on OCT in glaucoma and glaucoma suspect patients

Purpose

To identify the risk factors for development of peripapillary retinal splitting (schisis) in patients with glaucoma or suspicion of glaucoma

Setting

Glaucoma Clinic, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL

Methods

In this institutional cross-sectional study, 495 patients (990 eyes) who had undergone spectral-domain optical coherence tomography (OCT Spectralis HRA-OCT, Heidelberg Engineering) optic nerve head (ONH) imaging and did not have identifiable optic nerve pits, pseudopits or coloboma were included. OCT scans were reviewed by two observers.

Main outcome measures

Presence of peripapillary retinal splitting identified on OCT raster scans.

Results

Eleven of 990 glaucoma and glaucoma suspect eyes (1.1%) of 7 patients (2 females, 5 males, mean age 64.5 ± 9.2 years) had peripapillary retinal splitting. Two of these 11 eyes had extension of the splitting into the macula but none to the fovea. Of these 11 patients, 2 (28.6%) were glaucoma suspects, 3 (42.9%) had primary open-angle glaucoma, 1 (14.3%) had chronic angle-closure glaucoma and 1 (14.3%) had pigmentary glaucoma. 7/11 (63.6%) eyes had vitreous traction to the disc visualized on OCT and 6/11 eyes (54.5%) had beta-zone peripapillary atrophy.

Conclusions

We observed peripapillary retinal splitting in 1.1% of a series of 990 glaucoma and glaucoma-suspect eyes. Evidence of adherent vitreous with traction and peripapillary atrophy was found in a majority of the involved eyes. A comparison to an age and axial length matched cohort is required to determine if this is a condition that is associated with glaucoma.

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

PURPOSE

To determine if baseline fundoscopic and optical coherence tomography (OCT) features influence the clinical course of optic disk pit maculopathy.

METHODS

A multicenter retrospective case note review was undertaken, using standardized OCT and clinical data collection. Visual success was defined as at least a two-line visual acuity improvement, anatomical success as full resolution of OCT foveal fluid with restoration of the normal foveal contour, and partial anatomical success as incomplete resolution of the OCT foveal fluid. Outcomes were compared with a synthesis of the literature, using similar eligibility criteria.

RESULTS

Of 36 patients (36 eyes), 2 spontaneously improved and 34 underwent surgery. Visual success was achieved in 64% of surgical cases, anatomical success in 36%, and partial anatomical success in 47%. Cases with multilayer intraretinal and subretinal fluid were less likely to have visual success (P = 0.003). Cases where the fluid did not extend to the macular arcade vessels also had better visual and anatomical outcomes (P = 0.004 and 0.005, respectively).

CONCLUSION

Fundoscopic and OCT features can help predict surgical outcome in optic disk pit maculopathy.