Surgical outcomes in patients with optic disc pit maculopathy: does peeling the ILM lead to better outcomes?

Wagner, Helmuth O.; Pielen, Amelie; Agostini, Hansjürgen; Böhringer, Daniel; Lagrèze, Wolf A.; Biermann, Julia

doi:10.1007/s10792-020-01524-z

Cited by 6 publications

(4 citation statements)

References 47 publications

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“…All patients had complete macular reattachment and a reduction of CRT following surgery. None of the adjunctive procedures were significant predictors of resolution of macular detachment, IRF or CRT improvement, in line with other studies [ 4 , 12 , 15 ]. Some authors claim that even though endolaser and ILM peeling are associated with a faster anatomical result, these are not necessarily associated with better visual outcomes [ 10 , 18 ].…”

Section: Discussionsupporting

confidence: 89%

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

Pinheiro

Henriques

Figueira

et al. 2022

Case Rep Ophthalmol

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The purpose of this study was to compare the clinical outcomes of 13 patients with optic disc pit maculopathy (ODP-M) – progressive visual loss, serous macular detachment, and/or intraretinal fluid – who underwent different surgical approaches. This was a retrospective study including a consecutive sample of 13 patients aged 13–74 years (mean 35.38 ± 19.66 years) diagnosed with ODP-M and submitted to vitreoretinal surgery between 2005 and 2021. All patients underwent pars plana vitrectomy, posterior hyaloid detachment, and gas tamponade. Endolaser photocoagulation was applied to the temporal margin of the optic disc in 8 cases; internal limiting membrane (ILM) peeling was performed in 9 cases; and ILM inverted flap technique in 5 cases. Stuffing of the pit with an ILM flap was performed in 3 cases. Mean best-corrected visual acuity improved from 20/200 (1.04 ± 0.56 LogMAR) to 20/50 (0.43 ± 0.54 LogMAR) within 4–36 months. Central retinal thickness decreased from 587.5 ± 158.01 μm to 253.9 ± 33.55 μm, and 7 out of 10 patients had complete resolution of intraretinal fluid. All patients had complete retinal reattachment; however, a few years after surgery, 4 patients had recurrence of serous retinal detachment. The only adjunctive technique associated with greater visual improvement was endolaser (<i>p</i> = 0.033) and not performing peeling of the ILM was also associated with better visual results (<i>p</i> = 0.013), independently of preoperative visual acuity or age at the time of surgery. None of the adjunctive procedures was a significant predictor of better anatomical outcomes. In conclusion, all of these approaches for the surgical management of ODP-M were safe and effective. In this study, vitrectomy with endolaser was a good option for management of ODP-M.

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Section: Discussionsupporting

confidence: 89%

“…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.…”

Section: Discussionmentioning

confidence: 89%

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

Pinheiro

Henriques

Figueira

et al. 2022

Case Rep Ophthalmol

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“…There is also no overwhelming consensus as to whether combining PPV with ILM peeling can increase surgical success [41]. Although combining PPV with an inverted ILM flap and free ILM flap transplantation, autologous scleral flap, or platelets and using Tisseel fibrin sealant techniques have been associated with positive outcomes, Wagner et al demonstrated that ILM peeling did not significantly improve vision [6,42,43]. The multi-center European VitreoRetinal Society (EVRS) Optic Disc Study has provided up-to-date information about the surgery and highlighted that ILM peeling is in fact unnecessary; on the contrary, it was found to increase the risk of developing MHs and was not associated with better vision even though anatomical closure was achieved in some cases of retreatment [44].…”

Section: Discussionmentioning

confidence: 99%

Changes in Outcomes of Macular Optical Coherence Tomography Angiography Following Surgery for Optic Disc Pit Maculopathy

Akıdan,

Erol,

Gedik

et al. 2024

Diagnostics

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Purpose: we aimed to report on the optical coherence tomography angiography (OCTA) outcomes of eight patients with optic disc pit maculopathy (ODP-M) who were treated with 23-gauge pars plana vitrectomy (PPV). Methods: We examined sixteen eyes of eight patients—eight eyes with ODP-M and eight healthy fellow eyes. Fundus color photography, fundus autofluorescence, fundus fluorescein angiography, optical coherence tomography (OCT), and OCTA were performed. The vascular density, choriocapillaris blood flow (CCBF), and foveal avascular zone (FAZ) were analyzed using OCTA. Moreover, the correlation between the best-corrected visual acuity (BCVA) and macular OCTA parameters was assessed. Results: Compared with the healthy fellow eyes, the eyes with ODP-M preoperatively were found to have decreased BCVA, superficial capillary plexus (SCP) vascular density (i.e., total, foveal, parafoveal, and perifoveal), deep capillary plexus (DCP) vascular density (i.e., total, parafoveal, and perifoveal), and CCBF but a significantly increased FAZ (p < 0.05). When the eyes with ODP-M were analyzed pre- and postoperatively at month 12 after surgery, the BCVA, SCP vascular density (i.e., perifoveal), and CCBF had significantly increased, and the FAZ had significantly decreased (p < 0.05). When the eyes with ODP-M were compared with the healthy fellow eyes postoperatively at month 12, the BCVA, SCP, and DCP vascular density parameters had increased, along with CCBF, and the FAZ had decreased in eyes with ODP-M, though not to the levels of the healthy fellow eyes (p < 0.05). Moreover, a positive correlation was found between the postoperative BCVA and SCP total vascular density (p < 0.05). Conclusion: The BCVA and macular OCTA parameters improved in eyes with ODP-M at month 12 following surgery. However, the BCVA and OCTA of the eyes operated on did not reach the levels of the healthy fellow eyes, possibly due to impaired choroidal blood flow (CBF) recovery and the presence of a larger FAZ. In summary, OCTA seems to be useful for assessing qualitative and quantitative perioperative microvascular changes.

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“…ILM peeling may also facilitate the dispersion of subretinal and intraretinal fluids into the vitreous cavity. Some reports question the usefulness of gas tamponade and ILM peeling for macular retinoschisis associated with pit maculopathy [ 14 , 19 ]. Vitrectomy alone might have improved the macular retinoschisis in the present case.…”

Section: Discussionmentioning

confidence: 99%

Vitrectomy for macular retinoschisis associated with peripapillary intrachoroidal cavitations in a moderately myopic eye

Aoki

Imaizumi

2022

Int J Retin Vitr

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Background Peripapillary intrachoroidal cavitation (PICC), a cavernous change in the peripapillary choroid, may present with macular lesions. Here, we present a rare case of PICC with outer lamellar macular hole and macular retinoschisis. Case presentation A 69-year-old man presented with metamorphopsia in the left eye. Fundus examination revealed macular retinoschisis and PICCs. Pars plana vitrectomy with fovea sparing internal limiting membrane peeling (FSIP) was performed. Three weeks postoperatively, the patient developed rhegmatogenous retinal detachment and underwent a second vitrectomy. The macular retinoschisis resolved without macular hole formation and the patient’s visual acuity improved. There were no recurrent macular lesions over the three years of postoperative follow-up. Postoperative spectral-domain optical coherence tomography scan revealed a communication between the PICC and the vitreous cavity. Conclusions This case shed light on understanding development of PICC in non-highly myopic eyes and a rare complication of macular retinoschisis. Vitrectomy with FSIP may effectively resolve macular retinoschisis.

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Surgical outcomes in patients with optic disc pit maculopathy: does peeling the ILM lead to better outcomes?

Cited by 6 publications

References 47 publications

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

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

Changes in Outcomes of Macular Optical Coherence Tomography Angiography Following Surgery for Optic Disc Pit Maculopathy

Vitrectomy for macular retinoschisis associated with peripapillary intrachoroidal cavitations in a moderately myopic eye

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