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Georgiadis O, Pappelis K, McHugh JA, Moraitis A, Theodossiadis PG, Grabowska A. No optic pit serous maculopathy associated with an intraorbital optic nerve sheath lesion. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e393-e395. [PMID: 38503404 DOI: 10.1016/j.jcjo.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/25/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Odysseas Georgiadis
- Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", Chaidari, Greece
| | - Konstantinos Pappelis
- Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", Chaidari, Greece.
| | - James A McHugh
- King's College Hospital, NHS Foundation Trust, London, United Kingdom
| | - Alexandros Moraitis
- Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", Chaidari, Greece
| | - Panagiotis G Theodossiadis
- Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", Chaidari, Greece
| | - Anna Grabowska
- King's College Hospital, NHS Foundation Trust, London, United Kingdom
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Prabhu V, Venkatesh R, Kathare R, Acharya I, Mangla R, Handa A, Yadav NK, Chhablani J. Congenital versus acquired optic disc pit maculopathy: An OCT based study. Eur J Ophthalmol 2024; 34:1183-1190. [PMID: 37885202 DOI: 10.1177/11206721231210752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE The purpose of this study is to describe and compare the demographic, ocular, and imaging characteristics of a cohort of patients with congenital and acquired optic disc pit maculopathy (ODPM). METHODS This retrospective case series included patients diagnosed with ODPM between June 2017 and April 2023. These patients' baseline demographics, ocular characteristics, and optical coherence tomography (OCT) imaging characteristics and follow up changes were analyzed. RESULTS A total of 14 eyes with ODPM were identified (9 congenital and 5 acquired). Eyes with congenital ODP developed maculopathy at a younger age, presented commonly with visual symptoms, and exhibited an obvious pit at the temporal foveal margin as well as a high cup: disc ratio (p < 0.05). Primary open-angle glaucoma was identified in all five eyes with acquired ODPM. On OCT, eyes with acquired ODPM lacked the characteristic nerve fibre layer schisis, outer retinal layer hole, and foveal serous macular detachment (p < 0.05) unlike congenital ODPM. At the final follow-up visit, two cases from the congenital ODPM group and one case from the acquired ODPM group displayed complete resolution of maculopathy. The two cases of congenital ODPM were treated with pars plana vitrectomy and laser barrage to the optic disc margin, while the solitary case of acquired ODPM was treated with trabeculectomy surgery alone. CONCLUSION Clinical examination and baseline OCT imaging reveal distinct differences between congenital and acquired ODPM eyes. These characteristics may help with accurate diagnosis and treatment planning for these two distinct clinical entities.
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Affiliation(s)
- Vishma Prabhu
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Rupal Kathare
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Isha Acharya
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Rubble Mangla
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Ashit Handa
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
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Venkatesh R, Shroff S, Kathare R, Handa A, Prabhu V, Chhablani J. Successful resolution of serous macular detachment following glaucoma-filtering surgery alone for acquired optic disc pit maculopathy. Eur J Ophthalmol 2024; 34:NP87-NP91. [PMID: 38377952 DOI: 10.1177/11206721241234402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
PURPOSE To describe a case of acquired glaucomatous optic disc pit-related maculopathy successfully treated with glaucoma filtering surgery alone. CASE DESCRIPTION A 67-year-old male was diagnosed with advanced primary open angle glaucoma in both eyes, with a cup: disc ratio of 0.85 in the right eye and 0.95 in the left eye. Visual acuity at presentation was 20/60, and intraocular pressure was 14 mm Hg in the left eye. The fundus of the left eye revealed a serous macular retinal detachment due to an acquired optic disc pit. RESULTS The left eye of the patient underwent combined cataract and glaucoma filtering surgery. The serous macular detachment resolved completely 15 months after surgery, with a documented visual acuity of 20/40 and intraocular pressure of 10 mm Hg without the use of additional antiglaucoma medications. There was no recurrence of serous macular detachment even after the two-year follow-up visit. CONCLUSION This case demonstrates that controlling intraocular pressure alone resulted in complete resolution of serous macular detachment in acquired optic disc pit maculopathy without the need for pars plana vitrectomy.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Sujani Shroff
- Department of Glaucoma, Narayana Nethralaya, Bengaluru, India
| | - Rupal Kathare
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Ashit Handa
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Vishma Prabhu
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
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Arora S, Zur D, Iovino C, Chhablani J. Peripapillary fluid: Obvious and not so obvious! Surv Ophthalmol 2024; 69:311-329. [PMID: 38016521 DOI: 10.1016/j.survophthal.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
Intraretinal or subretinal fluid in the peripapillary area can be clinically visualized in conditions such as peripapillary choroidal neovascularization, optic disc pit maculopathy, and optic nerve head tumors and granulomas. Optical coherence tomography (OCT) helps to visualize peripapillary fluid in many other chorioretinal conditions such as peripapillary pachychoroid syndrome, posterior uveitis, central retinal vein occlusion, malignant hypertension, hypotonic maculopathy as well as neuro-ophthalmological conditions such as glaucoma, microcystic macular edema and disc edema due papilledema, non-arteritic anterior ischemic optic neuropathy, neuroretinitis, and diabetic papillopathy. Often, the differential diagnosis of peripapillary fluid is a bit tricky and may lead to misdiagnosis and improper management. We describe a diagnostic algorithm for peripapillary fluid on OCT and outline the salient features and management of these conditions.
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Affiliation(s)
- Supriya Arora
- Bahamas Vision Centre and Princess Margaret Hospital, Nassau NP, Bahamas
| | - Dinah Zur
- Division of Ophthalmology, 26738 Tel Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, United States.
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Akıdan M, Erol MK, Gedik B, Doğan ME, Başol I, Süren E. Changes in Outcomes of Macular Optical Coherence Tomography Angiography Following Surgery for Optic Disc Pit Maculopathy. Diagnostics (Basel) 2024; 14:874. [PMID: 38732289 PMCID: PMC11082969 DOI: 10.3390/diagnostics14090874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
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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Affiliation(s)
- Melih Akıdan
- Department of Ophthalmology, Antalya Akseki State Hospital, 07630 Antalya, Turkey
| | - Muhammet Kazım Erol
- Department of Ophthalmology, Antalya Training and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (M.K.E.); (E.S.)
| | - Birumut Gedik
- Department of Ophthalmology, Antalya Serik State Hospital, 07500 Antalya, Turkey;
| | | | - Ibrahim Başol
- Department of Ophthalmology, Antalya City Hospital, 07100 Antalya, Turkey;
| | - Elçin Süren
- Department of Ophthalmology, Antalya Training and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (M.K.E.); (E.S.)
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Landau Prat D, Kapelushnik N, Zloto O, Leshno A, Klang E, Sina S, Segev S, Arazi M, Soudry S, Ben Simon GJ. Prevalence of common and rare ophthalmic findings in adults attending a medical survey institute. Int Ophthalmol 2024; 44:43. [PMID: 38334834 PMCID: PMC10857980 DOI: 10.1007/s10792-024-03026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To examine the ophthalmic data from a large database of people attending a general medical survey institute, and to investigate ophthalmic findings of the eye and its adnexa, including differences in age and sex. METHODS Retrospective analysis including medical data of all consecutive individuals whose ophthalmic data and the prevalences of ocular pathologies were extracted from a very large database of subjects examined at a single general medical survey institute. RESULTS Data were derived from 184,589 visits of 3676 patients (mean age 52 years, 68% males). The prevalence of the following eye pathologies were extracted. Eyelids: blepharitis (n = 4885, 13.3%), dermatochalasis (n = 4666, 12.7%), ptosis (n = 677, 1.8%), ectropion (n = 73, 0.2%), and xanthelasma (n = 160, 0.4%). Anterior segment: pinguecula (n = 3368, 9.2%), pterygium (n = 852, 2.3%), and cataract or pseudophakia (n = 9381, 27.1%). Cataract type (percentage of all phakic patients): nuclear sclerosis (n = 8908, 24.2%), posterior subcapsular (n = 846, 2.3%), and capsular anterior (n = 781, 2.1%). Pseudophakia was recorded for 697 patients (4.6%), and posterior subcapsular opacification for 229 (0.6%) patients. Optic nerve head (ONH): peripapillary atrophy (n = 4947, 13.5%), tilted disc (n = 3344, 9.1%), temporal slope (n = 410, 1.1%), ONH notch (n = 61, 0.2%), myelinated nerve fiber layer (n = 94, 0.3%), ONH drusen (n = 37, 0.1%), optic pit (n = 3, 0.0%), and ON coloboma (n = 4, 0.0%). Most pathologies were more common in males except for ONH, and most pathologies demonstrated a higher prevalence with increasing age. CONCLUSIONS Normal ophthalmic data and the prevalences of ocular pathologies were extracted from a very large database of subjects seen at a single medical survey institute.
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Affiliation(s)
- Daphna Landau Prat
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel.
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
| | - Noa Kapelushnik
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Ofira Zloto
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Ari Leshno
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Eyal Klang
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
- The Sami Sagol AI Hub, ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Sigal Sina
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Shlomo Segev
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
- Institute for Medical Screening, Sheba Medical Center, Tel Hashomer, Israel
| | - Mattan Arazi
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | | | - Guy J Ben Simon
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
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Boscia G, Sborgia G, Niro A, Dore S, Landini L, Scotti G, Boscia F. Management of unresolved optic disc pit maculopathy with human amniotic membrane patch implant: A case report. Eur J Ophthalmol 2023; 33:NP128-NP132. [PMID: 36823771 DOI: 10.1177/11206721231159692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND/PURPOSE Inverted Inner Limiting Membrane (ILM)-flap approach can fail in the treatment of Optic disc pit maculopathy (ODPM). We report a surgical technique involving human amniotic membrane (hAM) patch implant to treat unresolved ODPM after inverted (ILM)-flap technique. CASE REPORT One patient with decreased visual acuity (1 LogMar) after unsuccessful inverted ILM-flap technique to treat ODPM, underwent hAM patch implant and was evaluated. A surgical approach including a 2 mm size graft patch of hAM implantation over the optic disc pit followed by fluid-air exchange was performed. A gas endotamponade was finally used. The patient was instructed to maintain face-down position for the first three days after surgery. The hAM patch remained detectable over the pit for the entire 6-months follow-up. The ODPM gradually resolved and visual acuity partially recovered to 0.17 LogMar during follow-up. No postoperative complications or recurrence were reported. CONCLUSION hAM patch implant may be effective to manage ODPM after unsuccessful inverted ILM-flap.
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Affiliation(s)
- Giacomo Boscia
- Eye Clinic Section, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Giancarlo Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "SS. Annunziata", ASL Taranto, Taranto, Italy
| | - Stefano Dore
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luca Landini
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Giacomo Scotti
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Francesco Boscia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
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Fujimoto S, Kokame GT, Ryan EH, Johnson MW, Hirakata A, Shirriff A, Ishikawa H, Adams OE, Bommakanti N. Macular Retinoschisis from Optic Disc without a Visible Optic Pit or Advanced Glaucomatous Cupping (No Optic Pit Retinoschisis [NOPIR]). Ophthalmol Retina 2023; 7:811-818. [PMID: 37271192 DOI: 10.1016/j.oret.2023.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE To review eyes with peripapillary and macular retinoschisis without a visible optic pit or advanced glaucomatous optic atrophy, or No Optic Pit Retinoschisis (NOPIR). DESIGN Retrospective multicenter case series. SUBJECTS The study included 11 eyes of 11 patients. METHODS Retrospective study of eyes with macular retinoschisis without a visible optic pit, advanced optic nerve head cupping, or macular leakage on fluorescein angiography. MAIN OUTCOME MEASURES Visual acuity (VA), retinoschisis resolution, months to resolution, and recurrence of retinoschisis RESULTS: The mean age was 68.1 ± 17.6 years, mean intraocular pressure was 17.4 ± 3.8 mmHg, and the mean spherical equivalent refractive error was -3.1 ± 2.9 diopters. No subject had pathologic myopia. Seven subjects were treated for glaucoma, and 9 subjects had nerve fiber layer defects on OCT. All eyes had retinoschisis in the outer nuclear layer (ONL) in the nasal macula and extending to the edge of the optic disc, and 8 subjects had fovea-involving retinoschisis. Three nonfoveal and 4 fovea-involved eyes were observed, and 4 fovea-involved eyes with vision loss underwent surgery. Surgery involved preoperative juxtapapillary laser followed by vitrectomy and membrane and internal limiting membrane peeling with intraocular gas and face-down position. The mean baseline VA was significantly worse in the surgery group than that in the observation group (P = 0.020). Retinoschisis resolved and vision improved in all surgical cases. The mean resolution time for the surgery group was 2.75 ± 0.96 months, which was shorter than that for the observation group (28.0 ± 21.2 months; P = 0.014). No eye developed recurrence of the retinoschisis after surgery. CONCLUSIONS Peripapillary and macular retinoschisis can develop in eyes without a visible optic pit or advanced glaucomatous cupping. Eyes without foveal involvement and those with foveal involvement but only mild decrease in vision can be observed for spontaneous resolution. If there is persistent foveal involvement with vision loss, surgery can improve vision by resolving the macular retinoschisis. Surgery for fovea-involved macular retinoschisis without a visible optic pit resulted in faster anatomic resolution and better vision recovery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | - Gregg T Kokame
- Hawaii Macula and Retina Institute, Aiea, Hawaii; University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii.
| | | | - Mark W Johnson
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Akito Hirakata
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ashley Shirriff
- University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii
| | - Hiroshi Ishikawa
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | | | - Nikhil Bommakanti
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
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Kudsieh B, Fernández-Vigo JI, Flores-Moreno I, Ruiz-Medrano J, Garcia-Zamora M, Samaan M, Ruiz-Moreno JM. Update on the Utility of Optical Coherence Tomography in the Analysis of the Optic Nerve Head in Highly Myopic Eyes with and without Glaucoma. J Clin Med 2023; 12:jcm12072592. [PMID: 37048675 PMCID: PMC10095192 DOI: 10.3390/jcm12072592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/11/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Glaucoma diagnosis in highly myopic subjects by optic nerve head (ONH) imaging is challenging as it is difficult to distinguish structural defects related to glaucoma from myopia-related defects in these subjects. Optical coherence tomography (OCT) has evolved to become a routine examination at present, providing key information in the assessment of glaucoma based on the study of the ONH. However, the correct segmentation and interpretation of the ONH data employing OCT is still a challenge in highly myopic patients. High-resolution OCT images can help qualitatively and quantitatively describe the structural characteristics and anatomical changes in highly myopic subjects with and without glaucoma. The ONH and peripapillary area can be analyzed to measure the myopic atrophic-related zone, the existence of intrachoroidal cavitation, staphyloma, and ONH pits by OCT. Similarly, the lamina cribosa observed in the OCT images may reveal anatomical changes that justify visual defects. Several quantitative parameters of the ONH obtained from OCT images were proposed to predict the progression of visual defects in glaucoma subjects. Additionally, OCT images help identify factors that may negatively influence the measurement of the retinal nerve fiber layer (RNFL) and provide better analysis using new parameters, such as Bruch’s Membrane Opening-Minimum Rim Width, which serves as an alternative to RNFL measurements in highly myopic subjects due to its superior diagnostic ability.
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Affiliation(s)
- Bachar Kudsieh
- Department of Ophthalmology, University Hospital Puerta De Hierro Majadahonda, 28220 Madrid, Spain
- Centro Internacional de Oftalmologia Avanzada, 28010 Madrid, Spain
- Correspondence: ; Tel.: +34-91-191-60-00
| | - José Ignacio Fernández-Vigo
- Centro Internacional de Oftalmologia Avanzada, 28010 Madrid, Spain
- Department of Ophthalmology, Hospital Clinico San Carlos, Institute of Health Research (IdISSC), 28040 Madrid, Spain
| | - Ignacio Flores-Moreno
- Department of Ophthalmology, University Hospital Puerta De Hierro Majadahonda, 28220 Madrid, Spain
| | - Jorge Ruiz-Medrano
- Department of Ophthalmology, University Hospital Puerta De Hierro Majadahonda, 28220 Madrid, Spain
- Instituto de Microcirugia Ocular (IMO), 28035 Madrid, Spain
| | - Maria Garcia-Zamora
- Department of Ophthalmology, University Hospital Puerta De Hierro Majadahonda, 28220 Madrid, Spain
| | - Muhsen Samaan
- Barraquer Eye Clinic UAE, Dubai P.O. Box 212619, United Arab Emirates
| | - Jose Maria Ruiz-Moreno
- Department of Ophthalmology, University Hospital Puerta De Hierro Majadahonda, 28220 Madrid, Spain
- Instituto de Microcirugia Ocular (IMO), 28035 Madrid, Spain
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10
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Corvi F, Nguyen TV, Juhn A, Corradetti G, Al-Sheikh M, Zweifel SA, Sadda SR. OPTIC DISK PIT ASSOCIATED WITH AN UNUSUAL OUTER RETINAL HOLE AND NASAL PERIPHERAL RETINOSCHISIS. Retin Cases Brief Rep 2023; 17:1-4. [PMID: 33394960 DOI: 10.1097/icb.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To document a peculiar case of optic disk pit-associated maculopathy with extensive nasal retinoschisis with lamellar outer retinal hole. METHODS A 41-year-old woman presented to the eye clinic complaining of new photopsias and enlargement of the blind spot in the left eye. Uncorrected visual acuity was 20/20 in both eyes. Fundus examination of the left eye revealed an anomalous appearing optic nerve with a gray oval depression at the temporal margin of the disk consistent with an optic disk pit. RESULTS Optical coherence tomography confirmed the presence of the pit and demonstrated outer plexiform layer schisis superonasal to the fovea and extensive inner and outer retinal schisis nasal to the nerve extending to the equator. A large lamellar outer retinal hole was noted nasal to the disk without associated retinal detachment. The vitreous appeared to be attached over the nasal retina. CONCLUSION Multimodal imaging revealed an unusual optic disk pit-associated retinopathy with dramatically more extensive retinoschisis and a lamellar outer retinal hole nasal to the nerve despite the temporal location of the pit. Although the precise pathophysiologic mechanisms are not fully understood, forces associated with the vitreo-retinal adhesion may have contributed to the distribution of the schisis in this case.
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Affiliation(s)
- Federico Corvi
- Doheny Eye Institute, University of California at Los Angeles, Los Angeles, California
- Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles
- Department of Biomedical and Clinical Science "Luigi Sacco," Eye Clinic, Sacco Hospital, University of Milan, Milan, Italy; and
| | - Tieu Vy Nguyen
- Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles
| | - Alexander Juhn
- Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles
| | - Giulia Corradetti
- Doheny Eye Institute, University of California at Los Angeles, Los Angeles, California
- Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles
| | - Mayss Al-Sheikh
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sandrine A Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - SriniVas R Sadda
- Doheny Eye Institute, University of California at Los Angeles, Los Angeles, California
- Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles
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11
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Peripapillary retinoschisis associated with glaucomatous optic neuropathy (clinical cases). OPHTHALMOLOGY JOURNAL 2022. [DOI: 10.17816/ov107586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Peripapillary retinoschisis is a rare condition and is detected more often in patients with glaucoma or glaucoma suspects, while data on the pathophysiological mechanisms of development and the effect on the course of glaucoma are limited. The article presents two clinical cases of unilateral peripapillary retinoschisis detected accidentally during a routine examination of patients with glaucoma.
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Li AS, Korot E, Mishra K, Perlroth A, Do DV. Wide-Field Swept-Source Optical Coherence Tomography of Optic Disc Pit Maculopathy Demonstrates Connection Between Vitreous and Subretinal Fluid. Ophthalmic Surg Lasers Imaging Retina 2022; 53:579-581. [PMID: 36239681 DOI: 10.3928/23258160-20220819-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The source of subretinal or intraretinal fluid in patients with optic disc pit maculopathy (ODP-M) remains unclear and is often thought to be either vitreous or cerebrospinal fluid.1 Here, we present the case of a 40-year-old man who developed ODP-M. Further imaging with wide-field swept-source optical coherence tomography demonstrated that the macular fluid was tracking from a nasal optic disc pit with superonasal communication to the vitreous. This suggests that swept-source optical coherence tomography can be a useful tool for determining the origin of macular fluid in patients with ODP-M. [Ophthalmic Surg Lasers Imaging Retina 2022;53:579-581.].
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Pathophysiological Heterogeneity of the BBSOA Neurodevelopmental Syndrome. Cells 2022; 11:cells11081260. [PMID: 35455940 PMCID: PMC9024734 DOI: 10.3390/cells11081260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/17/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
The formation and maturation of the human brain is regulated by highly coordinated developmental events, such as neural cell proliferation, migration and differentiation. Any impairment of these interconnected multi-factorial processes can affect brain structure and function and lead to distinctive neurodevelopmental disorders. Here, we review the pathophysiology of the Bosch–Boonstra–Schaaf Optic Atrophy Syndrome (BBSOAS; OMIM 615722; ORPHA 401777), a recently described monogenic neurodevelopmental syndrome caused by the haploinsufficiency of NR2F1 gene, a key transcriptional regulator of brain development. Although intellectual disability, developmental delay and visual impairment are arguably the most common symptoms affecting BBSOAS patients, multiple additional features are often reported, including epilepsy, autistic traits and hypotonia. The presence of specific symptoms and their variable level of severity might depend on still poorly characterized genotype–phenotype correlations. We begin with an overview of the several mutations of NR2F1 identified to date, then further focuses on the main pathological features of BBSOAS patients, providing evidence—whenever possible—for the existing genotype–phenotype correlations. On the clinical side, we lay out an up-to-date list of clinical examinations and therapeutic interventions recommended for children with BBSOAS. On the experimental side, we describe state-of-the-art in vivo and in vitro studies aiming at deciphering the role of mouse Nr2f1, in physiological conditions and in pathological contexts, underlying the BBSOAS features. Furthermore, by modeling distinct NR2F1 genetic alterations in terms of dimer formation and nuclear receptor binding efficiencies, we attempt to estimate the total amounts of functional NR2F1 acting in developing brain cells in normal and pathological conditions. Finally, using the NR2F1 gene and BBSOAS as a paradigm of monogenic rare neurodevelopmental disorder, we aim to set the path for future explorations of causative links between impaired brain development and the appearance of symptoms in human neurological syndromes.
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Mangum AJ. Case Report: Bilateral Cecocentral Visual Field Defect Secondary to Congenital Optic Disc Pit. Optom Vis Sci 2022; 99:308-314. [PMID: 35001062 DOI: 10.1097/opx.0000000000001864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Congenital optic disc pits are known to cause complications, commonly maculopathy due to retinoschisis and/or neurosensory retinal detachment. Retinal nerve fiber layer defects with associated visual field defects without maculopathy are another complication and can result in decreased visual function but have rarely been reported in the literature, especially bilaterally. PURPOSE This case report describes a patient with bilateral cecocentral visual field defects due to congenital optic nerve pits without associated maculopathy. CASE REPORT A 42-year-old Black man presented with blur symptoms at near uncorrected. Of note, there was no history of substance abuse or nutritional deficiencies. Best-corrected acuities were 20/20 in the right eye and 20/30 in the left eye. Clinical examination revealed bilateral focal grayish depression of the temporal optic nerve cup with associated papillomacular retinal nerve fiber layer defects. Optical coherence tomography (OCT) imaging revealed bilateral focal excavation of the temporal cup, temporal thinning of the retinal nerve fiber layer, and correlated binasal thinning of the ganglion cell complex, in the absence of retinoschisis or neurosensory detachment. Threshold visual field testing revealed stable bilateral cecocentral visual field defects. A diagnosis of bilateral cecocentral visual field defect secondary to congenital optic disc pits was made based on the patient's history and clinical examination. CONCLUSIONS A cecocentral visual field defect, unrelated to maculopathy, is a less common complication of congential optic disc pits that can cause decreased visual function. This case report provides evidence of this bilateral ocular condition and reviews the reported clinical, OCT, and threshold visual field manifestations of the disease. Specifically, spectral-domain OCT ganglion cell analysis seems useful in localizing the visual field defect.
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Inami W, Yoshikawa Y, Shibuya M, Kanno J, Kikuchi S, Sakaki Y, Katsumoto T, Shoji T, Makita J, Shinoda K. Quantitative assessment of macular function after surgery for optic disc pit maculopathy: A case report. Medicine (Baltimore) 2021; 100:e28254. [PMID: 34941100 PMCID: PMC8702281 DOI: 10.1097/md.0000000000028254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE We describe a case of optic disc pit maculopathy (ODP-M) in which vitrectomy with juxtapapillary laser (JPL) treatment led to the reattachment of retinoschisis (RS) as well as serous retinal detachment (SRD). PATIENT CONCERNS An 80-year-old man complained of distorted vision and decreased visual acuity (VA) in his left eye for 12 months. DIAGNOSIS We conducted quantitative functional evaluation on the area of RS and SRD using the Humphrey visual field analyzer. Fundus examination and optical coherence tomography showed SRD and RS in connection with the optic disc. The best-corrected logarithm of the minimum angle of resolution (logMAR) VA was 0.7. INTERVENTIONS The patient underwent JPL treatment combined with pars plana vitrectomy. During surgery, posterior vitreous detachment and tamponade were created with sulfur hexafluoride. OUTCOMES After surgery, SRD (and subsequently RS) gradually reduced and had completely disappeared at 31 months. VA gradually improved and was 0.0 (logMAR) at 28 months. The analysis of the mean macular thickness of the central 3-mm diameter showed that the macula thickness recovered to 300 μm at 17 months postoperatively. Retinal sensitivity began to improve at 24 months postoperatively and had increased at 48 months postoperatively. LESSONS In conclusion, vitrectomy with JPL treatment for ODP-M had a favorable anatomical outcome as well as a long-term functional outcome. These findings provide useful information for clinicians who are planning a therapeutic strategy, including the choice of surgical procedure for ODP-M.
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Iros M, Parolini B, Ozdek S, Gini G, Nawrocka ZA, Ellabban AA, Faramawi MF, Adelman R, Sallam AB, Meireles A, Lee CS, Ducournau D, Tsouris D, Kozina E, Patelli F, Viola F, Ascaso F, Becquet F, Tosi GM, Besozzi G, Oh H, Othman IS, Fiser I, Le Rouic J, Perone J, Amar J, Nawrocki J, Nascimento J, Arrevola L, Nagpal M, Mehrotra N, Demir M, Chelazzi P, Miesbauer P, Turkcuoglu P, Koch P, Uy R, Weinfurter SB, Bopp S, Park S, Schönherr U, Alsanova V, Bonfiglio V, Szijárt Z. Management of optic disc pit maculopathy: the European VitreoRetinal society optic pit study. Acta Ophthalmol 2021; 100:e1264-e1271. [PMID: 34877796 DOI: 10.1111/aos.15076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/26/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022]
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.
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Affiliation(s)
- Mariano Iros
- Instituto de Microcirugía Ocular Córdoba Córdoba Argentina
| | | | - Sengul Ozdek
- Department of Ophthalmology Faculty of Medicine Gazi University Ankara Turkey
| | - Giampaolo Gini
- Western Sussex NHS Trust and Nuffield Haywards Heath Hospital Sussex UK
| | | | - Abdallah A Ellabban
- Hull University Teaching Hospitals Hull UK
- Department of Ophthalmology Suez Canal University Ismailia Egypt
| | - Mohammed F. Faramawi
- Departments of Bioinformatics and Epidemiology University of Arkansas for Medical Sciences Little Rock AR USA
| | - Ron Adelman
- Department of Ophthalmology Yale University New Haven CT USA
| | - Ahmed B. Sallam
- Jones Eye Institute University of Arkansas for Medical Sciences Little Rock AR USA
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Torres Ledesma B, Bueno García P, Torres Pereda JP. Combined treatment for optic disc pit maculopathy secondary to glaucoma. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:668-672. [PMID: 34844689 DOI: 10.1016/j.oftale.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 11/18/2020] [Indexed: 06/13/2023]
Abstract
A 58-year-old man was referred to the retina specialist for evaluation of decreased vision in the left eye (LE). At the first visit, visual acuity was 0.9 in right eye (RE) and hands movement in LE, and the intraocular pressure (IOP) was 34 mmHg and 42 mmHg in right and left eye, respectively. Dilated funduscopic examination revealed papillary pallor, increased cup-to-disc ratio of the optic nerve in both eyes, and retinal posterior pole oedema in the LE. Optical coherence tomography (OCT) and fluorescein angiography assessment confirmed the diagnosis of a macular serous retinal detachment (RD) caused by an optic disc pit secondary to glaucoma. Combined surgical treatment with ExPress drainage device implantation, pars plana vitrectomy (PPV), and juxtapapillar laser endophotocoagulation was performed. The IOP returned to normal, as well as complete anatomical resolution of macular RD.
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Affiliation(s)
- B Torres Ledesma
- Complejo Hospitalario Universitario de Badajoz, Servicio de Oftalmología, Sección Retina, Badajoz, Spain.
| | - P Bueno García
- Complejo Hospitalario Universitario de Badajoz, Servicio de Oftalmología, Sección Retina, Badajoz, Spain
| | - J P Torres Pereda
- Complejo Hospitalario Universitario de Badajoz, Servicio de Oftalmología, Sección Retina, Badajoz, Spain
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Kelkar A, Kelkar JA, Bolisetty M, Kanoriya A. Management of Recurrent Optic Disc Pit-Associated Maculopathy with Human Amniotic Membrane Graft in a Pediatric Case: A Case Report. Case Rep Ophthalmol 2021; 12:734-739. [PMID: 34720971 PMCID: PMC8460937 DOI: 10.1159/000518808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/25/2021] [Indexed: 11/19/2022] Open
Abstract
A 13 years old previously operated with 25-G pars plana vitrectomy with double internal limiting membrane peel and juxtapapillary endolaser with SF 6 gas tamponade for optic disc pit-associated maculopathy (ODP-M), presented with recurrence after 9 months of successful primary surgery. Three 25-G sclerotomies were made and Human Amniotic Membrane Graft was tucked into the optic disc pit (ODP), the position of the graft was confirmed with intraoperative ocular coherence tomography. Subretinal fluid rapidly resolved within 48 h and best-corrected visual acuity improved to 0.5 LogMAR after 1 week. During the follow-up period of 12 months, no episodes of recurrence or reduction vision or adverse reactions were noted.
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Affiliation(s)
- Aditya Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, India
| | - Jai Aditya Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, India
| | - Mounika Bolisetty
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, India
| | - Ashwani Kanoriya
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, India
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19
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Meng L, Zhao X, Zhang W, Wang D, Chen Y. The characteristics of optic disc pit maculopathy and the efficacy of vitrectomy: a systematic review and meta-analysis. Acta Ophthalmol 2021; 99:e1176-e1189. [PMID: 33421324 DOI: 10.1111/aos.14730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the basic characteristics of optic disc pit maculopathy (ODPM) and the efficacies of pars plana vitrectomy (PPV) treatment with different adjunctive strategies. METHODS The databases PubMed, EMBASE and Ovid up to April 2020 were searched to identify relevant studies. Statistical analyses were conducted with R software version 3.6.3. RESULTS Fifty-nine studies were eventually included for different aspects of statistical analyses. The pooling results suggest the general incidence of maculopathy in optic disc pit (ODP) is 51%, and the rate of serous macular detachment and retinoschisis is 49% and 58%, respectively. The incidence of sub-retinal fluid (SRF) only is 10%, intra-retinal retinal (IRF) fluid only is 14%, and SRF plus IRF is 69%. A lamellar macular hole (LMH) is present in 53% of cases, and 58% have communication between the macula with the pit. The incidence of posterior vitreous detachment (PVD), vitreo-papillary traction and vitreomacular traction (VMT) is 7%, 28% and 13%, respectively. Besides, the rate of complete anatomic success and visual improvement after PPV are both around 85%. Subgroup analysis reveals the anatomic, and visual success rates of PPV alone are 89% and 100%, respectively. Gas tamponade, laser or internal limiting membrane peeling (ILMP) during vitrectomy are less promising, while PPV with ILM flap stuffing could achieve better outcomes than cases without it. CONCLUSION Optic disc pit-associated maculopathy has different fundus characteristics. Based on the current evidence, PPV is effective for ODPM, and the combined application of gas tamponade, laser and ILMP should be used with caution.
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Affiliation(s)
- Lihui Meng
- Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Xinyu Zhao
- Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Wenfei Zhang
- Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Dongyue Wang
- Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Youxin Chen
- Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
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Ray SK, Manz SN. BRAIN HEALTH ASSESSMENT IN MACULAR DEGENERATION PATIENTS UNDERGOING INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS (THE BHAM STUDY): An Interim Analysis. Retina 2021; 41:1748-1753. [PMID: 33346625 DOI: 10.1097/iae.0000000000003066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE After intravitreal injection, anti-vascular endothelial growth factor (VEGF) agents are found in the systemic circulation and can suppress systemic VEGF levels. Neuronal health and cognitive function in the central nervous system have been associated with normal physiological levels of VEGF expression. We wished to determine whether there was an association between cumulative anti-VEGF exposure and cognitive function. METHODS One hundred and seventy-five patients aged 65 to 85 with vision of at least 20/50 or better in one eye and a diagnosis of age-related macular degeneration took an iPad-based brain health assessment to determine their risk of mild cognitive impairment. The result for each patient was compared with the total number of anti-VEGF injections per individual patient. Patients were then stratified into groups with 0 injections (control), 1 to 9 injections, 10 to 20 injections, or greater than 20 injections. RESULTS The group of patients with more than 20 injections had a higher likelihood of mild cognitive impairment compared with the control group, with statistically significant worse mean Z-scores (P = 0.04). CONCLUSION Our study is the first to associate worsening cognitive health with higher cumulative anti-VEGF injections. This study was not designed to show a causal link, but does suggest that additional investigation is warranted.
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21
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Oli A, Balakrishnan D. Treatment outcomes of optic disc pit maculopathy over two decades. Ther Adv Ophthalmol 2021; 13:25158414211027715. [PMID: 34263136 PMCID: PMC8252332 DOI: 10.1177/25158414211027715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Aim To study the long-term outcomes of optic disc pit maculopathy. Methods Electronic medical records of 154 patients with optic disc pit were reviewed and 50 patients with optic disc pit maculopathy who met the study criteria were included in the study. Demographic profile of patients, along with clinical characteristics, optical coherence tomography (OCT) features and change in best-corrected visual acuity (BCVA) was recorded. Patients were treated either by observation, barrage laser alone or pars plana vitrectomy (PPV) with optional additional surgical procedures. The primary outcome measures were the change in BCVA and resolution of fluid on OCT. Results The mean age of patients was 29.96 years (3-62 years) with a follow-up of 27.16 months. The mean baseline BCVA in observation, laser and vitrectomy group was log MAR 0.94, 0.76 and 0.87 and final BCVA was log MAR 0.9, 0.67 and 0.46, respectively. There was a statistically significant improvement in the final BCVA and reduction in subretinal fluid with resolution of the schisis cavity in vitrectomy group than in other groups. On regression analysis significant association was found between final BCVA with baseline BCVA (R 2 = 0.815, p = 0.002), use of C3 F8 endotempanode (p = 0.004) ILM peeling (p = 0.012) and use of triamcinolone (TA; p = 0.003). No significant association was found with juxtapapillary endolaser (p = 0.062). Conclusions In patients with disc pit maculopathy, PPV lead to better functional and anatomical outcomes as compared to laser or observation alone. Use of surgical adjuvants like ILM peeling, TA and C3F8 tamponade improved the outcomes, unlike juxtapapillary endolaser treatment.
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Affiliation(s)
- Avadhesh Oli
- Smt Kanuri Santhamma Centre of Vitreoretinal diseases, LV Prasad Eye Institute, Kallam Anji Reddy Campus, L. V. Prasad Marg, Banjara Hills, Hyderabad 500034, Telangana, India
| | - Divya Balakrishnan
- Smt Kanuri Santhamma Centre of Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad, India
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22
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Muftuoglu IK, Tokuc EO, Karabas VL. Management of optic disc pit-associated maculopathy: A case series from a tertiary referral center. Eur J Ophthalmol 2021; 32:1720-1727. [PMID: 34132128 DOI: 10.1177/11206721211023727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report outcomes of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) stuffing technique in patients with optic disc pit associated maculopathy (ODP-M). METHODS Data including best-corrected visual acuity (BCVA), central macular thickness (CMT), foveal center point thickness (FCP), and maximum height of fluid (max_fluid) (intraretinal or subretinal) were collected from the medical records of the patients. RESULTS Six eyes of six patients with a mean age of 28.0 ± 17.68 years (range: 9-53 year) underwent PPV + ILM plug surgery. The mean follow-up duration was 25.62 ± 26.11 months (range: 11.80-78.00 month) duration. The mean BCVA increased from 1.25 ± 1.04 logMAR (20/355, Snellen equivalent) to 0.86 ± 1.09 logMAR (20/144, Snellen equivalent) at last follow-up (p = 0.043). Compared to baseline, CMT, FCP, and max_fluid significantly decreased at all visits after the surgery (p < 0.05 for all visits). At last follow-up, 66.6% of the eyes (four eyes) showed complete resolution of fluid at a mean of 5.25 ± 4.99 months (range: 1-12 months) after the surgery. CONCLUSION PPV with ILM plug seemed to be an effective surgical technique in ODP-M. Studies with longer follow-up and higher number of patients are needed to confirm our results.
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Affiliation(s)
- Ilkay Kilic Muftuoglu
- Istanbul Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Ecem Onder Tokuc
- University of Health Sciences Derince Training and Research Hospital, Department of Ophthalmology, Kocaeli, Turkey
| | - V Levent Karabas
- Kocaeli University School of Medicine, Department of Ophthalmology, Kocaeli, Turkey
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Babu N, Baliga G, Kohli P, Ramasamy K. Management of double optic disc pit complicated by maculopathy. Indian J Ophthalmol 2021; 68:663-665. [PMID: 32174600 PMCID: PMC7210862 DOI: 10.4103/ijo.ijo_1114_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Optic disc pit (ODP) is a rare, congenital, cavitary anomaly of the optic disc. Usually, single ODP occurs in an eye and only eleven cases of double ODP have been reported so far in the literature. In the present study, we report a case of unilateral double ODP, with both the pits present in opposite disc segments. They were associated with serous retinal detachment at the macula and retinal pigment epithelium degeneration nasal to disc. The case was managed successfully with vitrectomy, internal limiting membrane peeling, plugging the pits with homologous partial-thickness scleral flaps, and gas tamponade.
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Affiliation(s)
- Naresh Babu
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Girish Baliga
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Piyush Kohli
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Kim Ramasamy
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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Torres Ledesma B, Bueno García P, Torres Pereda JP. Combined Treatment for Optic Disc Pit Maculopathy Secondary to Glaucoma. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:S0365-6691(20)30483-4. [PMID: 33495054 DOI: 10.1016/j.oftal.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/14/2020] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
CASE REPORT A 58-year-old man was referred to the retina specialist for evaluation of decreased vision in the left eye (LE). At the first visit, visual acuity was 0.9 in right eye (RE) and hands movement in LE, and the intraocular pressure (IOP) was 34 mmHg and 42 mmHg in right and left eye, respectively. Dilated funduscopic examination revealed papillary pallor, increased cup-to-disc ratio of the optic nerve in both eyes, and retinal posterior pole edema in the LE. Optical coherence tomography (OCT) and fluorescein angiography assessment confirmed the diagnosis of a macular serous retinal detachment (RD) caused by an optic disc pit secondary to glaucoma. Combined surgical treatment with ExPress drainage device implantation, pars plana vitrectomy (PPV), and juxtapapillar laser endophotocoagulation was performed. IOP normalization was achieved as well as complete anatomical resolution of macular RD.
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Affiliation(s)
- B Torres Ledesma
- Complejo Hospitalario Universitario de Badajoz. Servicio de Oftalmología. Sección Retina, Badajoz, España.
| | - P Bueno García
- Complejo Hospitalario Universitario de Badajoz. Servicio de Oftalmología. Sección Retina, Badajoz, España
| | - J P Torres Pereda
- Complejo Hospitalario Universitario de Badajoz. Servicio de Oftalmología. Sección Retina, Badajoz, España
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25
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Torrado-Cobian LA, Fivgas GD. Optic nerve pit maculopathy worsened during pregnancy: a case report. BMC Ophthalmol 2021; 21:21. [PMID: 33413194 PMCID: PMC7791707 DOI: 10.1186/s12886-020-01775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report a case of Optic Disc Pit (ODP) maculopathy exacerbated during pregnancy. CASE PRESENTATION A 30-year-old female developed unilateral blurry vision at 10-weeks gestation. Ophthalmic examination revealed left eye reduced visual acuity (VA) with the presence of subretinal fluid temporal to the disc extending to the fovea. On Spectral Domain Optical Coherence Tomography (SD-OCT) subretinal, and intraretinal fluid was confirmed. Laser photocoagulation was tried in an attempt to prevent surgical intervention without success; subsequently, pars plana vitrectomy, internal limiting membrane peel and gas tamponade was performed. Three-weeks later, a full thickness macular hole developed, and repeat surgery was performed. Nine-months after the second surgery the macular hole was closed with near complete resorption of edema. CONCLUSIONS No trigger factors for ODP maculopathy have been reported before. We report a case of worsening ODP maculopathy during pregnancy with good visual outcome after surgical intervention.
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Affiliation(s)
- Laura A Torrado-Cobian
- Department of Ophthalmology, Retina Division, Louisiana State University (LSU) School of Medicine, 533 Bolivar Street, Room 451B, New Orleans, LA, 70112, USA
| | - George D Fivgas
- LSU Department of Ophthalmology, Retina Division, Private Practice: The Retina Center, 7777 Hennessy Blvd, Suite 3000, Baton Rouge, LA, 70808, USA.
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Vaniyan R, Falamarzi A, Shaikh MY. An Unusual Case of Pediatric Bilateral Congenital Optic Disc Pits With Unilateral High Myopia. Cureus 2021; 13:e12463. [PMID: 33552780 PMCID: PMC7854314 DOI: 10.7759/cureus.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Optic disc pits are rare congenital abnormalities. They are unilateral in 85% of the affected individuals. Optic disc pits occurring in the highly myopic eyes of the older adults are supposed to be acquired due to mechanical expansion of the disc from the axial elongation. High myopia is also a well described association of the optic disc pits of the congenital nature. We present a rare case of bilateral congenital optic disc pits in a 15-year-old girl having anisometropic unilateral axial myopia and the emmetropia in the fellow eye. This unique combination of the findings of unilateral high myopia in a child with bilateral congenital optic disc pits, to the best of our knowledge has not been described in the literature earlier. Our case demonstrates a scenario where two different causative factors for the optic disc pits may be present concurrently in the same instance.
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Affiliation(s)
- Ravi Vaniyan
- Ophthalmology, Royal Medical Services, Bahrain Defence Force Hospital, Riffa, BHR
| | - Aysha Falamarzi
- Ophthalmology, Royal Medical Services, Bahrain Defence Force Hospital, Riffa, BHR
| | - Mohamed Yusuf Shaikh
- Ophthalmology, Royal Medical Services, Bahrain Defence Force Hospital, Riffa, BHR
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27
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Makdoumi K, Crafoord S. 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. Acta Ophthalmol 2020; 98:822-827. [PMID: 32421253 DOI: 10.1111/aos.14475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022]
Abstract
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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Affiliation(s)
- Karim Makdoumi
- Department of Ophthalmology Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Sven Crafoord
- Department of Ophthalmology Faculty of Medicine and Health Örebro University Örebro Sweden
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28
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Newly Onset Optic Disc Pit Maculopathy (ODP-M) in a Patient With Primary Angle-closure Glaucoma (PACG) After Surgical Iridectomy: A Case Report. J Glaucoma 2020; 29:e44-e49. [PMID: 32282435 PMCID: PMC7266000 DOI: 10.1097/ijg.0000000000001512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Supplemental Digital Content is available in the text. Optic disc pit maculopathy (ODP-M) is a subtype of ODP, characterized by a serous retinal detachment and/or macular retinoschisis. Currently, ODP and ODP-M pathogenesis remain unknown although many hypotheses exist about their clinical features. In this study, we report a case of new ODP-M detected after surgical iridectomy in a patient with primary angle-closure glaucoma (PACG) with a preoperative normal retina and optic nerve. Fine optic disc and the macular area structures were investigated using several imaging techniques. Findings revealed that the course of ODP and ODP-M provide us with some insights and understanding of their underlying pathogenesis.
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29
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Sousa DC, Okada M, Chiu D, Allen P. Re: Michalewska et al: Swept-Source OCT and Swept-Source OCT Angiography before and after Vitrectomy with Stuffing the Optic Pit. Ophthalmol Retina 2020; 4:e8-e9. [PMID: 32896367 DOI: 10.1016/j.oret.2020.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 04/22/2020] [Accepted: 06/11/2020] [Indexed: 11/25/2022]
Affiliation(s)
- David Cordeiro Sousa
- Vision Sciences Study Center, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital, Victoria, Australia.
| | - Mali Okada
- Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Daniel Chiu
- Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Penelope Allen
- Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital, Victoria, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Victoria, Australia; Department of Surgery (Ophthalmology), University of Melbourne, Victoria, Australia
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30
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Pastor-Idoate S, García-Arumí Fusté C, García-Onrubia L, Copete S, García-Arumí J. Surgical Options for Optic Disc Pit Maculopathy: Perspectives and Controversies. Clin Ophthalmol 2020; 14:1601-1608. [PMID: 32606575 PMCID: PMC7308761 DOI: 10.2147/opth.s250921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
Optic disc pit (ODP) is a rare congenital optic nerve head abnormality, which can be complicated by intraretinal and subretinal fluid at the macula (ODP-maculopathy) with progressive visual loss. The source of this fluid remains unclear and the most dominant hypotheses have pointed to vitreous cavity or cerebrospinal fluid. Although spontaneous resolution has been reported, the majority of untreated cases of ODP-maculopathy result in final visual acuity less than 20/200 or worse. A wide array of interventions, either individually or in combination with adjuvant treatments, have been tried with varying degrees of success. Recently, different surgical procedures to fill the ODP by self-sealing materials in combination with pars plana vitrectomy have been reported as an effective adjuvant treatment. However, given the relative rarity of this condition, the majority of reports describe a small retrospective case series, making it difficult to compare among different treatments options and create a consensus regarding the optimal treatment for ODP-maculopathy. In this situation, a mini-review about surgical treatment modalities and their results can be a useful approach to identify the most effective surgical option in the management of ODP-maculopathy.
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Affiliation(s)
- Salvador Pastor-Idoate
- IOBA Eye Institute, University of Valladolid, Valladolid, Spain.,Clinical University Hospital of Valladolid, Valladolid, Spain.,Red Temática de Investigación Cooperativa en Salud (RETICS), Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - Claudia García-Arumí Fusté
- Vall d´Hebron University Hospital, Barcelona, Spain.,Ophthalmology Research, Vall d´Hebron Research Institute (VHIR), Barcelona, Spain
| | | | | | - José García-Arumí
- Red Temática de Investigación Cooperativa en Salud (RETICS), Oftared, Instituto de Salud Carlos III, Madrid, Spain.,Vall d´Hebron University Hospital, Barcelona, Spain.,Ophthalmology Research, Vall d´Hebron Research Institute (VHIR), Barcelona, Spain.,Ocular Microsurgery Institute (IMO), Barcelona, Spain.,Department of Ophthalmology, Autonomous University of Barcelona, Barcelona, Spain
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31
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Rapizzi E, Gallon P, Ponzin D, Ferrari S, Zemella N. A Conservative Surgical Approach to the Treatment of Optic Disc Pit Maculopathy: Four Case Reports. Case Rep Ophthalmol 2020; 11:196-204. [PMID: 32595483 PMCID: PMC7315137 DOI: 10.1159/000507880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/13/2020] [Indexed: 12/27/2022] Open
Abstract
The purpose of this report is to present the outcomes of surgical interventions in 4 patients with maculopathy associated with optic disc pit (ODP). We report 4 cases of patients affected by ODP maculopathy and treated by core vitrectomy with induction of posterior vitreous detachment and peeling of the internal limiting membrane restricted to the interpapillary macular zone without laser treatment and gas tamponade. The patients had rapid resolution of the multilayer inner retinoschisis-like separation and progressive slow reabsorption of the macular intraretinal and subretinal fluid up to complete retinal reattachment. Currently, there are still no widely accepted guidelines related to the best technique in the management of the maculopathy associated with ODP. We used a conservative approach, without the adoption of intravitreal gas injection or laser.
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Affiliation(s)
- Emilio Rapizzi
- Department of Ophthalmology, Ospedale dell'Angelo, ULSS3 Serenissima, Venice, Italy
| | - Paola Gallon
- Fondazione Banca degli Occhi del Veneto, Venice, Italy
| | - Diego Ponzin
- Fondazione Banca degli Occhi del Veneto, Venice, Italy
| | - Stefano Ferrari
- Fondazione Banca degli Occhi del Veneto, Venice, Italy
- *Stefano Ferrari, Fondazione Banca degli Occhi del Veneto, Via Paccagnella 11, IT–30174 Zelarino, Venice (Italy),
| | - Nicola Zemella
- Department of Ophthalmology, Ospedale dell'Angelo, ULSS3 Serenissima, Venice, Italy
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32
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Vitrectomy with peripapillary internal limiting membrane peeling for macular retinoschisis associated with normal-tension glaucoma. Am J Ophthalmol Case Rep 2020; 18:100663. [PMID: 32215342 PMCID: PMC7090242 DOI: 10.1016/j.ajoc.2020.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/05/2020] [Accepted: 03/07/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Although vitrectomy has been reported to be effective for the treatment of macular retinoschisis associated with glaucoma in a few case series, the surgical techniques have yet to be established. This article aimed to describe the cases of two patients with macular retinoschisis who underwent vitrectomy with peripapillary internal limiting membrane peeling around the defective area of the retinal nerve fiber layer. Observations Both patients had been diagnosed with normal tension glaucoma and treated with eye drops to stabilize intraocular pressure. Progression of macular retinoschisis and accompanied vision loss were observed in both cases. Twelve months after the surgery, both patients had resolution of the retinoschisis and improvement in best corrected visual acuity. Conclusions and importance Our surgical technique may be effective for the resolution of macular retinoschisis in eyes with normal tension glaucoma.
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