Comparison of Inverted ILM-Stuffing Technique and ILM Peeling Alone for Optic Disc Pit-Associated Maculopathy: Long-Term Results

Abstract

BACKGROUND AND OBJECTIVE: To evaluate long-term outcomes of inverted internal limiting membrane (ILM) stuffing into the optic disc pit for optic disc pit maculopathy (ODP-M) compared with vitrectomy with ILM peeling alone. PATIENTS AND METHODS: Twelve eyes of 12 patients who underwent vitrectomy for ODP-M and followed up more than 12 months were included. We retrospectively analyzed outcomes of inverted ILM flap stuffing into ODP (group 1, n = 6) with ILM peeling alone (group 2, n = 6). RESULTS: At 12 months, both groups showed significant improvement in best-corrected visual acuity and central macular thickness. On comparison, significantly faster resolution of maculoschisis was found in group 1 compared with group 2 ( P = .012). CONCLUSIONS: Pars plana vitrectomy (PPV) with ILM peeling and PPV with inverted ILM stuffing are effective treatment modalities for ODP-M, with inverted ILM stuffing showing faster resolution of maculoschisis. [ Ophthalmic Surg Lasers Imaging Retina . 2018;49:e226–e232.]

Optic nerve pit maculopathy worsened during pregnancy: a case report

“…Many techniques have been described to prevent a FTMH from happening such as vitrectomy alone, vitrectomy and PVD induction and ILM peeling but none of them have shown any improvement in anatomy or visual acuity [17,18]. Taking into consideration that FTMH has been reported in up to 57% of the cases and has been attributed to peeling over thinned-out retina as previously described by Shukla and co-authors [1,7,17], we might question if ILM peeling is necessary. However, ILM peeling relieves the tangential traction needed to prevent the passage of fluid from the ODP to the macula [17].…”

“…Maculopathy is a well described condition occurring in 25-75% of patients with ODP and being responsible for significant vision loss in up to 65% of the patients [1,4,[9][10][11]. Macular changes described are serous detachment, cystoid degeneration, degenerative pigmentary changes and macular schisis [1,[6][7][8]12]. Even though some reports describe spontaneous resolution in about 25% of patients, the majority have a poor visual prognosis with 80% of patients reporting a visual acuity of 20/ 200 or worse [4,6,7,13].…”

“…Optic disc pit (ODP) is a rare congenital defect of the optic nerve characterized by a grayish oval depression at the optic disc, most frequently found at the inferotemporal region [1][2][3][4][5][6][7][8]. Even though maculopathy has been reported to be triggered after childbirth, there are no known factors that might precipitate or are associated with worsening optic disc maculopathy [4].…”

<p>Surgical Options for Optic Disc Pit Maculopathy: Perspectives and Controversies</p>

“…39 In addition, there are numerous surgical series showing excellent results without ILM peeling. [23][24][25]40,41 Thus, this maneuver seems to be questionable and probably not essential in the treatment of most cases of ODP-M. Creation of an inner retinal fenestration 28 or glial tissue removal, 29 procedures that involve risk of optic nerve injury, fall short of providing adequate evidence to be recommended for ODP-M, as they did not show an increment in the surgical success rate.…”

“…42 Maybe in those cases, the key point for obtaining a successful surgery could be the emergence of recent adjuvant treatments that are principally focused on sealing the pit. The justification for sealing the ODP with different materials such as ILM flap (Figure 1), 14,[41][42][43][44][45][46] fibrin glues 47,48 or autologous fibrin, 49 homologous scleral tissue 50 or even silicone lacrimal plug, 51 is based on the recent hypothesis postulated by Jain and Johnson, 7 in which different pressure ranges between the eye and intracranial pressure can lead to migration of fluid from the vitreous cavity or CSF to intraretinal or subretinal space due to a defect either in the lamina cribrosa or the juxtapapillary area. 7 Therefore, from a theoretical point of view, a procedure to create a "broad plug" along the "involved" disc margin could prevent the translaminar difference of pressure or block the outflow of fluids to the retinal layers or subretinal space.…”