Resolution of optic disc pit-associated macular retinoschisis after topical carbonic anhydrase inhibitor treatment: Report of a case

Intraocular Pressure Lowering Associated With Worsening Optic Pit-Like Retinoschisis

In this article, we present a case of optic pit-like macular retinoschisis in the absence of advanced glaucomatous cupping. Intraocular pressure (IOP)-lowering therapy, which was started due to an early concern for glaucoma, caused a worsening of the retinoschisis, which subsequently resolved on discontinuation of the IOP-lowering therapy. Lower IOP likely triggered intraretinal fluid accumulation by facilitating a translaminar gradient from the subarachnoid to intraretinal space. [Ophthalmic Surg Lasers Imaging Retina 2024;55:100-102.].

Minimally invasive procedure for optic disc pit maculopathy: vitrectomy with scleral plug and analysis on pattern of resolution

Optic disc pit maculopathy (ODP-M) is a rare complication of optic disc pit which can cause irreversible visual impairment. The aim of this study is to evaluate the anatomical and functional outcomes and pattern of resolution of ODP-M following vitrectomy with posterior vitreous detachment (PVD) induction and scleral tissue plug for treatment of ODP-M without ILM peeling, laser or use of long term gas/tamponade or head positioning. This retrospective study included 7 patients with ODP-M, meeting the inclusion criteria. Patients were followed up for 6 months. Complete anatomical success was defined as "Total resolution of all the fluid in retinal compartments". All of the patients had complete resolution of the optic pit maculopathy following surgery. The mean duration for complete resolution was 18.3 weeks. Pattern of resolution of ODP-M was found to be resolution of the subretinal fluid (SRF) followed by disappearance of the retinoschitic lesions (RL) and finally disappearance of macular edema (ME). The proposed minimally invasive procedure (MIP) can produce comparably good and equally reliable results for the treatment of ODP-M.

Congenital optic disc pits and optic disc pit maculopathy: a review

Optic disc pits are a rare but significant anomaly of the optic nerve head that can lead to visual impairment and associated complications. These pits are characterized by a small, oval-shaped depression in the disc, which can cause fluid accumulation and subsequent damage to the adjacent retina. Although the etiology and pathogenesis of optic disc pits are not fully understood, several theories have been proposed, including abnormal embryonic development and degenerative changes. Diagnosis is typically made through a comprehensive eye examination, including a dilated fundus exam and optical coherence tomography. Management options vary depending on the severity of the condition and associated complications, ranging from observation to surgical intervention.

Optic Pit Maculopathy: Adjunctive Treatment Using Oral Spironolactone and Topical Dorzolamide

Purpose

There is no consensus for the treatment of optic disc pit maculopathy (ODPM). We describe a case of ODPM refractory to vitrectomy that was successfully treated with systemic spironolactone and topical dorzolamide 2%.

Methods

Case report.

Results

A 27-year-old male was referred for decreased vision in the right eye secondary to macular edema. Fundus examination and optical coherence tomography imaging revealed an optic pit maculopathy with significant macular schisis and intraretinal fluid. After an initial observation period, we performed pars plana vitrectomy with internal limiting membrane peeling, fibrin glue, and gas endotamponade. At the 2 months postoperative follow-up, anatomic and functional outcomes remained unimproved. Oral spironolactone and topical dorzolamide 2% were, therefore, added. Significant reduction in the intraretinal fluid and macular schisis was demonstrated at the last follow-up 2 years postoperative.

Conclusion

The mechanisms underlying optic disc pit maculopathy remain controversial, and treatment guidelines are unclear. To our knowledge, this is the first description of an OPDM treated with a combination systemic mineralocorticoid receptor antagonist and topical carbonic anhydrase inhibitor as adjuvant therapy to vitrectomy with favorable outcomes. We also review the literature and propose mechanisms through which these treatment entities may act.