LONG-TERM OUTCOMES OF RADIAL OPTIC NEUROTOMY FOR MANAGEMENT OF OPTIC DISK PIT MACULOPATHY

Multilayered Inverted Internal Limiting Membrane Flap Technique in Optic Disc Pit Maculopathy

Objectives

To evaluate the anatomical and visual outcomes of the multilayered inverted internal limiting membrane (ML-ILM) flap technique in the treatment of optic disc pit maculopathy (ODPM).

Materials and Methods

In this retrospective interventional case series, medical records and macular spectral-domain optical coherence tomography images of patients who underwent combined pars plana vitrectomy with ML-ILM flap surgery for ODPM were analyzed. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) at postoperative 6 months were compared with baseline findings. Intraoperative and postoperative complications, fluid resolution time, and recurrence during follow-up were recorded.

Results

Five eyes of 5 patients with ODPM were included in the study. According to the preoperative macular fluid characteristics, 2 patients had only intraretinal fluid, while 3 patients had intraretinal and subretinal fluid. The preoperative median BCVA was 1.0 logarithm of the minimum angle of resolution (logMAR) (range, 1.0-1.3 logMAR), and the CMT was 560 μm (range, 452-667 μm). At the 6-month postoperative follow-up, the median BCVA was 0.40 logMAR (range, 0.1-0.7 logMAR), and CMT was 315 μm (range, 265-326 μm) (p=0.042 and p=0.043, respectively). During the 6-month follow-up period, no recurrence or full-thickness macular hole formation was observed.

Conclusion

The ML-ILM flap technique is a preferable surgical option to achieve both high anatomical and functional success and flap stabilization.

Optic Disk Pit Maculopathy Treatment Using a Human Amniotic Membrane Patch: One-Year Results

PURPOSE

To report the 1-year results of human amniotic membrane patch implantation for optic disc pit maculopathy.

DESIGN

A prospective, consecutive, interventional study.

METHODS

Eleven eyes of 11 patients affected by optic disc pit maculopathy associated with subretinal/intraretinal fluid were included in this single-institution study. A 25-gauge pars plana vitrectomy was performed in all cases, with an implant of a human amniotic membrane patch into the optic disc pit and air was injected as endotamponade. The primary study outcome was the subretinal and intraretinal fluid reabsorption. Secondary outcomes were visual acuity improvement and postoperative complications.

RESULTS

Mean central retinal thickness gradually diminished from 512 ± 137 µm to 243 ± 19 µm, at the 12-month follow-up. The mean visual acuity improved from 20/80 at baseline to 20/32 at the 12-month follow-up. Complete fluid resorption occurred in 9 of 11 (81.8%) eyes and there was partial resorption in 2 eyes (18%). No subretinal fluid recurrence was observed during the 12-month follow-up. No intraoperative or postoperative complications were reported during the follow-ups. The amniotic membrane patch remained detectable inside the pit for the entire follow-up time.

CONCLUSION

An amniotic membrane plug may be effective for improving optic disc pit maculopathy. All cases had an anatomical improvement and encouraging visual acuity recovery.

Optic Disc Pit Maculopathy: New Perspectives on the Natural History

PURPOSE

To investigate the natural history of optic disc pit maculopathy and explore the associations between demographic, anatomic, and functional characteristics.

DESIGN

Retrospective, comparative case series.

METHODS

This was a single-center medical record review of previously untreated optic disc pit maculopathy. Baseline data of visual function, demographics, and pit physiognomy were collected, and further subgroup analysis was undertaken on patients with long-term follow-up, according to whether they were monitored or received surgical intervention. LogMAR visual acuity was the primary outcome measure, and anatomic characteristics were reported where available.

RESULTS

Eighty-seven patients were identified with a new presentation of optic disc pit maculopathy. No demographic or pit features were correlated with vision at baseline. In 51 patients with available optical coherence tomography data, only the presence of subretinal fluid at baseline was associated with poorer visual acuity (P < .001). Fifty-two patients who were monitored without treatment had available long-term follow-up data. The mean change in visual acuity in this group was 0.01, with 77% maintaining visual acuity ≤0.30. Twenty-seven patients underwent surgery and showed significant postoperative improvement in vision (P < .001), with 59% achieving an acuity ≤0.30. Duration of postoperative follow-up was associated with better visual acuity (P = .007).

CONCLUSION

Many patients with optic disc pit maculopathy maintain good long-term visual acuity and may demonstrate resolution of subretinal fluid in the absence of surgical intervention. There may be evidence to support delaying surgical treatment until visual deterioration is observed because of the potential stability or spontaneous improvement of the condition, the high rate of reoperation, and the long-term positive outcomes of deferred intervention.

Optic disk pits and optic disk pit maculopathy: A review

Optic disk pit, one of the optic disk cavitary anomalies, is generally congenital and unilateral and occurs equally in males and females. Optic disk pit maculopathy is characterized by intraretinal and subretinal fluid at the macula, causing visual deterioration. The origin of the macular fluid and the mechanism of transition to the subretinal space in optic disk pit maculopathy pathophysiology are not yet fully understood. With the evolution of imaging modalities, especially optic coherence tomography, our knowledge of this disorder continues to increase. Although many different treatments have been tried, there is no consensus on the most effective.