Successful surgical treatment of optic disc pit maculopathy

Abstract

patients with scleritis develop bilateral disease, 50% of whom have delayed onset in the fellow eye, mostly of the same type of scleritis. 8 A high index of suspicion may uncover this sight-threatening but treatable condition. Occasionally a patient with medical training will experience the symptoms of a disorder that may provide a unique opportunity to determine the exact nature of the symptom. This has occurred in the past with lightning flashes from posterior vitreous detachment (PVD) because Moore published the findings of his own photopsia in 1947. 1 We describe an ophthalmologist colleague who suffered bilateral PVD with specific symptoms of black flashes for a brief period before the onset of the typical lightning flashes. One of the authors (LW) a 51-year-old female ophthalmologist with À5.5 D right eye and À6.0 D left developed acute PVD in the left eye. The first symptoms she noticed were black coloured flashes in the inferotemporal periphery. These were momentary, vertically orientated and occurred in a flickering pattern before subsiding and then returning again. After 6 h, they were replaced by white flashes and floaters. She was examined by THW and found to have a PVD with Weis ring. Seven years later, she developed in the right eye a similar pattern of black flashes for 2 h before they were replaced by white flashes and floaters from PVD (confirmed by THW). We suspect that many patients forget or disregard this initial symptom because these flashes are soon replaced by white lightning flashes. Since the presentation by LW, we have on specific questioning found black flashes to be present in other individuals with PVD. The symptom may be due to traction on the axons of the surface of the optic nerve by the vitreous as the PVD process creates the Weis ring thus interrupting the signal from the retina. The fact that the PVD has not yet occurred is suggested by the appearance of floaters and white lightning flashes only after the black flashes have disappeared. Evidence that the PVD process can be traumatic to the optic nerve head can be seen in some patients who develop haemorrhages on the surface of the optic nerve head after PVD. 2,3 This is the first description of black photopsia in PVD that we are aware of. References

Long-term outcomes of pars plana vitrectomy without internal limiting membrane peeling for optic disc pit maculopathy

“…Differences in techniques result from the selection of adjuvant procedures such as short or long-acting gas tamponade, ILM peeling, endolaser photocoagulation in the peripapillary area and drainage of subretinal fluid. [27][28][29][30]33,[35][36][37][40][41][42][43][44][45][46][47] Hirakata et al 22 reported favourable results in 10 out of 11 patients treated with vitrectomy and gas exchange without endolaser photocoagulation. Hirakata et al 36 have also recently reported good surgical outcomes with vitrectomy but without laser treatment or gas tamponade for macular detachment with an optic disc pit.…”

“…Although various surgical techniques with different success rates have been reported in literature, [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] PPV with gas endotamponade seems to be the preferred procedure when surgery is selected. Differences in techniques result from the selection of adjuvant procedures such as short or long-acting gas tamponade, ILM peeling, endolaser photocoagulation in the peripapillary area and drainage of subretinal fluid.…”

“…4,11,[29][30][31][32] Although pars plana vitrectomy (PPV) and gas tamponade was performed at least twenty years ago, this procedure with or without inner limiting membrane (ILM) peeling has become more widespread in recent years. 28,[33][34][35][36][37][41][42][43][44][45][46][47] Endolaser photocoagulation to the temporal edge of optic disc is controversial and not applied by all authors. 20,22,36 Recently, intraretinal or subretinal fluid drainage has been reported as an additional procedure.…”

Pars Plana Vitrectomy with Air Tamponade for Optic Disc Pit Maculopathy: Swept-source Optical Coherence Tomography Imaging Findings and Surgical Approach: A Clinical Case

“…We reported a successful anatomical outcome with improvement of visual acuity from counting fingers to 6/18 [6].…”

“…Treatment modalities reported for ODP maculopathy include various combinations of PPV, gas tamponade, laser photocoagulation to the temporal juxtapapillary area, internal limiting membrane (ILM) peeling, internal drainage of submacular fluid or macular scleral buckling procedure [4][5][6][7].…”