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

Haruta, Masatoshi; Kamada, Rika; Umeno, Yumi; Yamakawa, Ryoji

doi:10.2147/opth.s34962

Cited by 14 publications

(7 citation statements)

References 16 publications

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“…Eleven months into the post-operative period, the macula was reattached. The subsequent reduction of the diameter of the optic pit suggests potential pre-operative traction from the vitreous in maintaining the patency of the pit (Figure 2) The pre-operative absence of a posterior vitreous detachment in our case may also have contributed to our good surgical result, as this was reported to be a positive prognostic factor by Haruta et al [5].…”

Section: Discussionsupporting

confidence: 49%

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

IC¹

2015

J Clin Exp Ophthalmol

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Purpose: To describe how Swept Source Optical Coherence Tomography (SS-OCT) provides enhanced diagnostic information enabling optimisation of surgical strategy in a pediatric patient suffering from ODP maculopathy. We report the first case of successful management of ODP maculopathy via pars plana vitrectomy (PPV) and air tamponade. Methods: Interventional case report.Results: A five-year-old girl presented with ODP and serous macular detachment in her previously amblyopic left eye. SS-OCT showed optically opaque vitreous fibres perpendicularly attached to the base of the optic nerve head excavation and what appeared to be fibrous tissue at the base of the excavation of the optic nerve head and attached to the pit. Detachment of the posterior hyaloid was induced during PPV, the pre-optic nerve head fibrosis was removed with forceps and fluid/air exchange was carried out to induce air tamponade. The serous macular detachment had resolved 11 months after the surgery and the optic pit was reduced in size. No maculopathy recurrences or complications such as cataract were observed. Best corrected visual acuity did not improve possibly because of pre-existing amblyopia.Conclusion: SS-OCT demonstrated anatomical features not previously described in ODP maculopathy and could assist in the choice of surgical technique. In patients with ODP maculopathy and documented optic nerve head vitreous attachment with peri-pit fibrosis, vitrectomy supplemented by tamponade with air alone may be a viable alternative to tamponade with gas with or without laser photocoagulation. This modified technique may reduce the risk of complications such as cataract formation.

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Section: Discussionsupporting

confidence: 49%

“…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].…”

Section: Discussionmentioning

confidence: 99%

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

IC¹

2015

J Clin Exp Ophthalmol

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“…Lastly, vitreomacular or vitreopapillary traction secondary to incomplete vitreous separation is another plausible mechanism. [ 1 , 26 – 30 ] [ 31 ] In our series, 7/11 (63.6%) of the eyes with peripapillary schisis had evidence of adherent vitreous with traction at the nerve in contrast to 13/979 (1.33%) of eyes without peripapillary schisis, while 404/979 (41.3%) eyes without peripapillary schisis had vitreopapillary adhesion without traction. In a series of 13 POAG eyes with microcystic INL changes similar to schisis, Hasegawa et al reported that the vitreous was attached in the area of microcystic INL spaces in 76.9% of eyes.…”

Section: Discussionmentioning

confidence: 62%

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

et al. 2017

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PurposeTo identify the risk factors for development of peripapillary retinal splitting (schisis) in patients with glaucoma or suspicion of glaucomaSettingGlaucoma Clinic, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, ILMethodsIn 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 measuresPresence of peripapillary retinal splitting identified on OCT raster scans.ResultsEleven 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.ConclusionsWe 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.

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“…However, all three eyes with maculopathy belonged to young patients without PVD, suggesting an association of the posterior hyaloid adhering to the optic disc with the pathogenesis of maculopathy. In addition, of four eyes with optic disc pit maculopathy, two without preoperative PVD showed resolution of maculopathy after PPV with induction of PVD, whereas the other two eyes with no resolution belonged to elderly patients having PVD before surgey 10. Taken together, this suggests that in young patients without PVD, the posterior hyaloid adhering to pits may exert traction on the disc and cause maculopathy, whereas, in elderly patients with PVD such as ours, remnant tissue contraction on the disc is likely to be a driving force similar to the posterior hyaloid or epiretinal membranes.…”

Section: Discussionmentioning

confidence: 85%

“…In two eyes with glaucoma developing retinal schisis without PVD, retinal schisis was reduced after PPV with intraoperative PVD formation 3. Based on these observations, it is suggested that traction of the posterior hyaloid to the optic disc plays a role in the onset of retinal schisis associated with optic disc pits or a glaucomatous disc without PVD 1,8,10…”

Section: Discussionmentioning

confidence: 98%

Membrane tissue on the optic disc may cause macular schisis associated with a glaucomatous optic disc without optic disc pits

Takashina¹,

Saito²,

Noda³

et al. 2013

OPTH

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This article reports a case of possible involvement of membrane tissue on the optic disc with macular schisis formation associated with glaucomatous optic disc without optic disc pits. A 78-year-old man presented with loss of central visual acuity of the left eye. He had a medical history of primary open-angle glaucoma. Visual acuity was 0.6 in his left eye, and funduscopy revealed macular schisis and a glaucomatous optic disc without optic disc pits. Optical coherence tomography (OCT) revealed membrane tissue on the optic disc and a tunnel-like hyporeflective lesion connecting the schisis cavity and a site near the tissue, but no obvious optic disc pit. He underwent pars plana vitrectomy during which the membrane tissue on the disc and internal limiting membrane were removed. Posterior vitreous detachment was observed intraoperatively. Thereafter, the tunnel-like lesion observed on OCT was rapidly obscured and the macular schisis gradually reduced. Eighteen months after surgery, his visual acuity had improved to 0.9 with almost complete regression of the macular schisis. No optic disc pit was visualized after surgery. The changes in OCT findings described here suggest an etiology for macular schisis without optic disc pits in an eye with a glaucomatous optic disc with posterior vitreous detachment. A connection between the schisis cavity and the vitreous cavity may have appeared via the tunnel-like structure due to the membrane tissue exerting traction on the optic disc.

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

Cited by 14 publications

References 16 publications

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

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

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

Membrane tissue on the optic disc may cause macular schisis associated with a glaucomatous optic disc without optic disc pits

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