Management of optic disc pit maculopathy: the European VitreoRetinal society optic pit study

Abstract

Purpose: To evaluate a variety of techniques, and their anatomical and functional results, for the treatment of optic disc pit maculopathy (ODP-M). A secondary aim was to report on results of secondary procedures in cases of initial failure or recurrence. Methods: Multicentre retrospective study of 95 eyes with ODP-M, treated by 25 surgeons from 12 countries. Primary outcomes were anatomical resolution of subretinal fluid (SRF), intraretinal fluid (IRF) and visual acuity (VA) at 12 months. Results: Higher rates of SRF and IRF resorption were achieved in eyes treated with pars plana vitrectomy (PPV) compared to external laser with or without tamponade: 64/ 72 (88.9%) versus 8/14 (57.1%) for SRF (p = 0.003), and 50/59 (84.7%) versus 3/10 (30%) for IRF (p = 0.002). The addition of juxtapapillary laser or internal limiting membrane (ILM) peel during PPV did not improve SRF or IRF resolution. Pars plana vitrectomy (PPV) with tamponade and PPV with tamponade plus endolaser were associated with significant visual gain. In the former group, VA improved from a mean of logMAR 0.91 (20/162), to a mean of logMAR 0.52 (20/66) at 12 months; in the latter group, VA improved from a mean of logMAR 0.82 (20/132) to a mean of logMAR 0.47 (20/59) at 12 months. Retreatments were performed in 14 eyes (15.7%), only enhancing anatomical outcomes. Conclusion: Vitrectomy with tamponade had better final outcomes than external laser treatment with or without gas tamponade. Laser endophotocoagulation and ILM peel provided no additional benefit. A secondary treatment resulted in anatomical but not functional improvement.

Surgical Approaches to Optic Disc Pit Maculopathy: A Clinical Case Series

“…In this analysis, however, patients who did not undergo ILM peeling had better visual outcomes independently of preoperative BCVA or age at surgery (Table 1). Other authors have reached the same conclusions [14][15][16], and both the 2014 EVRS Optic Pit Study [17] and a recent review [3] do not support the need for ILM peeling.…”

“…Endolaser photocoagulation can theoretically create a scar that will act as a barrier to communication between the pit and the inner retinal layers and thus prevent leakage of fluid to the macula [ 10 , 11 ], and from these results, endolaser led to significantly better visual outcomes. Nevertheless, this procedure is not without risks, and some prior studies concluded that endolaser provided no additional benefit for ODP-M [ 12 , 13 , 14 ]. The ILM might exert tangential force on the retina and contribute to the maculopathy, and its removal ensures hyaloid detachment in the macular area [ 13 ].…”

“…However, neither the ILM flap nor ILM stuffing influenced VA improvement in this study, which is in line with two recent reviews [ 3 , 4 ]. Regarding gas endotamponade, there were no differences in VA improvement between the SF6 and C3F8 groups, and other reviews highlight only the importance of gas tamponade following vitrectomy, as the gas acts as a temporary barrier between the vitreous cavity and the ODP and also pushes the intraretinal fluid into the outer layer of detachment, facilitating reattachment of the retina, regardless of the type of gas used [ 1 , 14 ].…”

OCT-angiography in optic disk pit after inverted ILM flap: A case report

“…The rarity and very low prevalence of the disease makes the choice very difficult, yet nowadays PPV is the standard of choice and is usually performed after the presence of a macular detachment. 5,6 Nowadays there is a general agreement on an attendance interval of 3 months from the appearance of ODP-M before PPV, in order to ward photoreceptor layer disruption off after the launch of anaerobic pathway and the production of increased lactic acid, dextrose and phospholipids. 7 Regarding the…”

“…European Journal of Ophthalmology 34 (1) intraoperative procedures that we can offer to these patients, the most recent comparative studies have demonstrated that juxtapapillary laser photocoagulation is not necessary as it has similar functional other than anatomical results compared to PPV without laser. 5,8 Furthermore, among the intraoperative options that we can offer it seems that ILM plugs have a more lasting effect compared to other plugging techniques. 9 Post-operative SD-OCT of this case report patient complies with literature data about the persistence of subretinal liquid (mainly composed of hyaluronic acid) for 1-2 years after surgical operation.…”