Vitrectomy for optic disc pit maculopathy: a long-term follow-up study

Bottoni, Ferdinando; Cereda, Matteo Giuseppe; Secondi, Roberta; Bochicchio, Sara; Staurenghi, Giovanni

doi:10.1007/s00417-018-3925-9

Cited by 27 publications

(23 citation statements)

References 36 publications

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“…Also, of the patients with attached macula, 80% required more than 180 days for reattachment to occur. This is in keeping with previous studies that showed that improvement of vision is related to restoration of the normal retinal morphology [10-14, 19, 21, 22, 25-31]. This becomes progressively more evident 6–12 months postoperatively, as submacular fluid is slow to resolve (Table 3).…”

Section: Discussionsupporting

confidence: 91%

“…Improvement of vision was achieved in 89% of our cases, with a mean visual gain of almost 3 lines on the Snellen chart at the end of the follow-up time, and 67% had a final BCVA of 0.5 or better. This compares favourably with other functional results [10-14, 19, 22, 25-31]. Similar functional outcomes have been reported by D’Souza et al [16] and Nawrocki et al [17] using the same surgical procedure.…”

Section: Discussionsupporting

confidence: 90%

“…Certainly, the best clinical evidence to determine which treatment is superior in patients with ODP maculopathy would be obtained through a randomized clinical trial of different adjuvant surgical procedures to PPV [10, 11, 13, 14, 18, 22, 25, 28-30]. However, it is unlikely that such a trial can be performed for this very rare clinical entity.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Internal Limiting Membrane Flap Techniques with Vitrectomy for Macular Detachment Associated with an Optic Disc Pit

et al. 2019

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Purpose: To compare the anatomical and functional outcome of adjuvant pars plana vitrectomy (PPV) procedures using the techniques of translocation of an internal limiting membrane (ILM) flap and transplantation of an inverted ILM flap for the treatment of chronic and/or refractory optic disc pit (ODP) maculopathy. Methods: In this prospective interventional case series study, 9 patients (9 eyes) with chronic and/or refractory ODP maculopathy underwent PPV with either translocation of an ILM flap or transplantation of an inverted ILM flap as adjuvant techniques along with gas tamponade. The anatomical success, rates of macular reattachment, and visual improvement were assessed. Results: The mean preoperative central retinal thickness (CRT) was 723.4 µm (range: 366–1,151). The mean postoperative CRT was 398.1 ± 212.2 µm (range: 210–758). An increased preoperative CRT was associated with a lower chance of postoperative reattachment of the macula (p = 0.047). The overall reattachment rate at the end of the follow-up period was 56% (n = 5). The mean preoperative visual acuity (logMAR unit [Snellen acuity]) was 0.48 (20/60) (range: 1.30 [20/400] to 0.10 [20/25]). The mean change in best corrected visual acuity (BCVA) was 0.48 ± 0.233 logMAR units (approx. 3 lines of visual improvement). Conclusions: ILM flap techniques are logical and straightforward approaches as adjuvants to PPV treatment of ODP maculopathy. They could be viable adjuvant treatments for improvement in BCVA and CRT in patients with ODP maculopathy.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Efficacy of Internal Limiting Membrane Flap Techniques with Vitrectomy for Macular Detachment Associated with an Optic Disc Pit

et al. 2019

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“…This report uniquely demonstrates a very large maculoschisis cavity in the outer retina with a prominent PMC. In contrast to many other ODP reports that show shallow schisis channels overlying relatively large macular detachments,11,14 here a “giant” schisis cavity developed and apparently remained a pure maculoschisis until finally breaking through a microscopic outer layer hole to form a small detachment at the fovea (Figure 1C), as first described by Lincoff et al4…”

Section: Discussioncontrasting

confidence: 62%

<p>Optic disc pit maculopathy: tamponade of maculoschisis</p>

Morris

Hashimi²,

McFarland

et al. 2019

OPTH

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PurposeTo present rapid and safe closure of the pit-macula communication (PMC) by core vitrectomy and adequate duration gas tamponade as our preferred method of resolving optic disc pit (ODP) maculopathy and to define the term “maculoschisis” in ODP maculopathy as an alternative to the term “schisis-like.”Patient and methodsA twenty-four-year-old female presented with an optical coherence tomography (OCT) confirmed ODP and a “giant” communicating maculoschisis cavity. Central macular thickness (CMT) measured 906 microns, and macular volume was twice normal, at 20.8 mm3. Snellen corrected visual acuity was 20/70. Two months after initial vitrectomy performed elsewhere with short-term gas tamponade (SF6 20%), CMT and visual acuity were not significantly improved. Combined lens extraction/intraocular lens placement and repeat vitrectomy with C3F8 15% gas tamponade were performed, with one supplemental (office) gas injection.ResultsOCT imaging six weeks postoperatively showed definitive closure of the PMC with CMT reduced by 405 microns. Sequestered from its ODP source, foveal schisis fluid then resolved by 12 weeks postoperatively. At final follow-up 3.4 years postoperatively, the macula remained dry with a CMT of 322 microns and a concave foveal contour. Macular volume was reduced to (a normal) 10.2 mm3 and visual acuity had improved to 20/25.ConclusionNo report heretofore has documented rapid, sustained closure of the PMC by gas tamponade as the preferred method of expeditiously resolving ODP maculopathy. However, tamponade PMC closure sequesters ODP fluid and uniquely provides early assurance of ultimate maculopathy resolution. In all other techniques, PMC closure is a trailing phenomenon and success remains uncertain during months to a year or more of (unsequestered) fluid resolution. We suggest that more invasive techniques (laser barrier application to the peripapillary choroid, vitreoretinal interface maneuvers, and pit-plugging) be withheld unless a recurrence is detected during subsequent examinations.

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“…Relatively few investigations have evaluated surgical and visual outcomes from a long-term perspective (Avci et al 2013;Ooto et al 2014;Rayat et al 2015;Abouammoh et al 2016;Bottoni et al 2018;Bloch et al 2019). In the present study, we aimed to investigate the results of patients who operated at the € Orebro University Hospital for ODP, with the purpose of assessing long-term surgical results, anatomical healing, as well as present visual function and symptoms (Table 1).…”

Section: Introductionmentioning

confidence: 99%

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

Makdoumi

Crafoord

2020

Acta Ophthalmologica

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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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Vitrectomy for optic disc pit maculopathy: a long-term follow-up study

Abstract: Vitrectomy with induction of PVD is a safe and successful therapeutic option for the treatment of optic disc pit maculopathy. The adjunct of ocriplasmin might facilitate the induction of PVD and reduce the risk of iatrogenic retinal holes.

Cited by 27 publications

References 36 publications

Efficacy of Internal Limiting Membrane Flap Techniques with Vitrectomy for Macular Detachment Associated with an Optic Disc Pit

Efficacy of Internal Limiting Membrane Flap Techniques with Vitrectomy for Macular Detachment Associated with an Optic Disc Pit

<p>Optic disc pit maculopathy: tamponade of maculoschisis</p>

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

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