Double-Vitrectomy for Optic Disc Pit Maculopathy

Abstract

Background: The origin of the fluid and precise pathophysiology of optic pit maculopathy remain unclear. It has been suggested that submacular fluid originates either from vitreous or cerebrospinal fluid. We report a case of optic pit maculopathy which was unsuccessfully treated with vitrectomy and internal limiting membrane (ILM) peeling, and subsequently resolved with revision of vitrectomy and gas tamponade. Methods: We report a case of optic disc pit maculopathy, well documented by spectral- domain optical coherence tomography, before and after pars plana vitrectomy with ILM peeling, and its revision with gas tamponade. Results: After ILM peeling, there was no improvement either in visual acuity or in the tomographic aspect of the retina. A revision of the surgery was then needed and gas tamponade was performed, which resulted in a complete resolution of the optic pit maculopathy. Conclusion: The absence of improvement after ILM peeling during the first surgical procedure, accompanied by resolution of the clinical picture with gas tamponade during the second surgical procedure, sustained the hypothesis of a subarachnoidal origin of the fluid.

Macular Detachment Associated with an Optic Pit: Optical Coherence Tomography Patterns and Surgical Outcomes

“…This fact may suggest that pneumatic retinopexy can be an effective surgical option in vitrectomized eyes which failed to achieve fluid absorption and macular anatomic resolution. This observation is supported by an additional published case report in which there was no improvement after PPV and ILM peeling during the first surgical procedure, and resolution of the clinical picture was accomplished with gas tamponade only (24).…”

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

“…The reduction in vitreous traction might not be the only explanation for the visual improvement after vitrectomy and gas tamponade. In addition, the shift of subretinal fluid either back into the subarachnoidal space [ 4 , 18 , 35 ] or into the replaced vitreous space [ 17 ] after gas tamponade may be involved. In our institution, PPV with gas tamponade is the standard for the treatment of ODP-M, which is combined with ILM-peeling at the discretion of the surgeon.…”

Optic disc pit maculopathy: when and how to treat? A review of the pathogenesis and treatment options

“…Based on these results, it has been suggested that laser photocoagulation at the temporal disc border may not be required for successful treatment of ODP-M. Gas tamponade has been performed in the vast majority of published cases, as it is used to create a temporary barrier blocking the passage of fluid thorough the ODP. Interestingly, anecdotal cases have been reported of surgical interventions without gas tamponade that failed to improve ODP-M, but when intravitreal gas was injected in a second procedure the fluids have resolved [68, 69]. In another series of 7 patients treated with PPV and PVD induction without laser or gas tamponade, VA had improved but the fluids did not resolve completely [38].…”