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

Abstract

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.

Optic nerve pit maculopathy worsened during pregnancy: a case report

“…There is no universally accepted management, but the current standard treatment of ODP maculopathy is PPV, with posterior vitreous detachment induction, ILM peeling, peripapillary laser, fluid-air exchange and gas tamponade [5,11,13]. Other new innovative techniques described to seal the ODP include inverting peeled ILM into the ODP, ILM chunk transplantation, Tissel fibrin sealant, autologous scleral tissue flap and autologous platelet injection on the optic pit [7,10,13,16].…”

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

“…Currently, there is no optimal accepted treatment for ODP-M because the pathogenesis of the disease is not yet fully understood. However, since vitreous traction, specifically the vitreopapillary traction, 2,5,[16][17][18] has been suggested to play an important role in the pathogenesis of ODP-M, pars plana vitrectomy (PPV) with the induction of posterior vitreous detachment (PVD) remains the most widely accepted treatment of choice for this entity. [9][10][11][12][13][19][20][21][22] Tight vitreous attachment over the optic nerve has been reported in previous studies preoperatively by OCT and intraoperatively by iOCT in ODP-M patients.…”

“…[9][10][11][12][13][19][20][21][22] Tight vitreous attachment over the optic nerve has been reported in previous studies preoperatively by OCT and intraoperatively by iOCT in ODP-M patients. 16,17,23 Therefore, inducing a PVD by PPV can relieve the traction exerted by the vitreous on either the macula or the ODP, facilitating the absorption of subretinal fluid. Most of the published literature on ODP-M is focused on PPV techniques which have evolved along with the breakthroughs.…”

The characteristics of optic disc pit maculopathy and the efficacy of vitrectomy: a systematic review and meta‐analysis

“…2018; Pastor‐Idoate et al. 2019). Besides vitrectomy, laser photocoagulation at temporal optic disc rim, gas tamponade and macular buckling is also reported as effective interventions for ODPM (Brockhurst 1975; Akiyama et al.…”