A Case Report of Optic Disc Pit Maculopathy in an 8-Year-Old Boy: Vitrectomy with Internal Limiting Membrane Flap in a Child

Purpose: To compare the anatomical and functional outcome of adjuvant pars plana vitrectomy (PPV) procedures using the techniques of translocation of an internal limiting membrane (ILM) flap and transplantation of an inverted ILM flap for the treatment of chronic and/or refractory optic disc pit (ODP) maculopathy. Methods: In this prospective interventional case series study, 9 patients (9 eyes) with chronic and/or refractory ODP maculopathy underwent PPV with either translocation of an ILM flap or transplantation of an inverted ILM flap as adjuvant techniques along with gas tamponade. The anatomical success, rates of macular reattachment, and visual improvement were assessed. Results: The mean preoperative central retinal thickness (CRT) was 723.4 µm (range: 366–1,151). The mean postoperative CRT was 398.1 ± 212.2 µm (range: 210–758). An increased preoperative CRT was associated with a lower chance of postoperative reattachment of the macula (p = 0.047). The overall reattachment rate at the end of the follow-up period was 56% (n = 5). The mean preoperative visual acuity (logMAR unit [Snellen acuity]) was 0.48 (20/60) (range: 1.30 [20/400] to 0.10 [20/25]). The mean change in best corrected visual acuity (BCVA) was 0.48 ± 0.233 logMAR units (approx. 3 lines of visual improvement). Conclusions: ILM flap techniques are logical and straightforward approaches as adjuvants to PPV treatment of ODP maculopathy. They could be viable adjuvant treatments for improvement in BCVA and CRT in patients with ODP maculopathy.

Purpose: To report four patients with optic disc pit-maculopathy (ODP-M) treated with transplantation of internal limiting membrane (ILM) flap, obtained by two different ILM peeling techniques, into the optic disc pit (ODP). Method and Patients: One eye of 4 patients with ODP-M underwent 23 gauge pars plana vitrectomy. Three patients underwent ILM peeling, free ILM flap transplantation to ODP, and 15-17% perfluoropropane (C3F8) gas tamponade. In these 3 patients, the ILM was transplanted to ODP after complete peeling. In one patient, the nasal fragment of the ILM was left unpeeled and then the peeled ILM flap was folded over the unpeeled portion and transplanted into ODP. Results: Serous macular detachment and intraretinal multilayered fluid regressed at the end of the postoperative 3rd month in all cases. In all patients, macular thickness decreased and best-corrected visual acuity (BCVA) increased in the postoperative 3rd month. An unexpected macular hole (MH) developed in two patients (Case 2, 3). In one of these patients, MH was closed by peeling the wider ILM, and it was observed that BCVA increased. Conclusions: ILM flap transplantation to ODP has been observed as an effective surgical technique for the treatment of ODP-M. In addition, a wider ILM peeling was

Purpose: To report a case of macular serous retinal detachment and macular thinning associated with optic disc pit maculopathy successfully treated with vitrectomy, fovea-sparing internal limiting membrane (ILM) peeling, and inverted ILM flap technique.Case summary: A 27-year-old male patient presented with a 1-month history of decreased right eye vision. Corrected visual acuity in the right eye was 0.025 at initial visit. Fundus examination revealed an oval, deep-seated defect in the inferotemporal portion of the optic nerve and a chorioretinal coloboma located inferior to the optic nerve with a one-third disc diameter. Optical coherence tomography (OCT) showed severe macular serous detachment and central foveal thinning. Surgical treatment comprised vitrectomy, ILM peeling preserving an amount of ILM equivalent to the diameter of one disc in the central fovea and covering the optic disc pit with an inverted ILM flap from its nasal portion. The flap was fixed with a dispersible viscoelastic material and intravitreal 20% sulfur hexafluoride gas injection. The patient was maintained in a facedown position for 3 days postoperatively. After 15 months, the best-corrected visual acuity of the right eye improved to 0.63. Repeat OCT revealed resolution of retinoschisis and serous retinal detachment, with the ILM flap effectively covering the optic disc pit.Conclusions: Fovea-sparing ILM peeling with an inverted ILM flap on the nasal side over the optic disc pit in patients with thin inner retinal layers and excessive serous retinal detachment effectively prevent the occurrence of macular holes and treat optic disc pit maculopathy.

ABSTRACTPurpose: To evaluate macular thickness (MT) changes, using spectral domain optical coherence tomography (SD-OCT) in patients with optic disc pit (ODP) maculopathy after pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling. Procedures: Our retrospective study included nine patients with ODP maculopathy, treated with either PPV (n = 5) or PPV with ILM peeling (n = 4). All participants, who had a mean long-term follow-up of 33.4 ± 7.0 months, underwent a complete ophthalmological examination and SD-OCT. Due to the preoperative macular elevation, the postoperative MT in the operated patients was compared with that of fellow eyes and with normative data. Results: A significant reduction in MT was noticed in all macular sectors of the operated cases at the last examination. The reduction was more evident in the group of PPV with ILM peeling. At the last examination of the follow-up, there was a statistically significant improvement regarding BCVA in both groups in comparison with baseline, while the two groups did not differ significantly in between (p = 0.245). Conclusions: In the long-term follow-up period, our study demonstrated a significant reduction in MT in patients with ODP maculopathy treated with PPV, which was more profound in those cases where PPV included ILM peeling.

Purpose The present review describes the procedures that intervene directly in covering and stuffing the optic disc pit (ODP). Methods We made a comprehensive review of the literature regarding the new treatment modalities for the treatment of ODP maculopathy, mainly concentrated on covering and stuffing of the ODP. We presented the anatomical and functional outcomes of these techniques in patients with ODP maculopathy, while potential risks and complications of these techniques are also discussed. Results The most commonly used treatment alternative for ODP maculopathy is vitrectomy, which seems to be more successful if it is associated with the covering of the ODP by internal limiting membrane (ILM) inverted flapping. The results of the procedure are successful, if the origin of the fluid comes from the vitreous cavity. Another new procedure aims at the stuffing of the ODP by rolled ILM-flap, autologous scleral tissue or human amniotic membrane, providing promising anatomical results. The so far anatomical and functional results are discussed in detail. The literature, however, is limited regarding these techniques and based mainly on case reports with short-term follow-up. Additionally, the stuffing technique is possible to provoke further damage of optic nerve tissue and remain challenging in its use. Conclusions Both covering and stuffing techniques of the ODP seem to have promising results, when used as adjunct to vitrectomy. One should take into account special considerations and possible further complications for their use in the treatment of ODP maculopathy.

IntroductionWe present a case of a man with optic disc pit maculopathy, whose vision improved after vitrectomy combined with glial tissue removal from the optic pit area, and without the use of photocoagulation.Case presentationA 45-year-old man complained of blurred vision, and ophthalmoscopy revealed a retinal detachment and retinoschisis extending from an optic disc pit through the macula in his left eye. He was diagnosed with optic disc pit maculopathy, and vitrectomy was performed. A posterior vitreous detachment was created, glial tissue at the optic pit was removed, and octafluoropropane (C3F8) was injected as a gas tamponade. The retinal detachment and retinoschisis disappeared after six months, and vision improved to 20/20 without any visual field defects (Goldmann perimetry). A cataractous lens was extracted 2 years after the vitrectomy, and vision has remained 20/20 for 10 years without any recurrence.ConclusionThe removal of glial tissue during vitrectomy may be beneficial in patients with optic disc pit maculopathy.

Optical Coherence Tomography Before and After Vitrectomy with Internal Limiting Membrane Removal in a Child with Optic Disc Pit Maculopathy

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 (p = 0.033) and not performing peeling of the ILM was also associated with better visual results (p = 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.

This article reports a case of possible involvement of membrane tissue on the optic disc with macular schisis formation associated with glaucomatous optic disc without optic disc pits. A 78-year-old man presented with loss of central visual acuity of the left eye. He had a medical history of primary open-angle glaucoma. Visual acuity was 0.6 in his left eye, and funduscopy revealed macular schisis and a glaucomatous optic disc without optic disc pits. Optical coherence tomography (OCT) revealed membrane tissue on the optic disc and a tunnel-like hyporeflective lesion connecting the schisis cavity and a site near the tissue, but no obvious optic disc pit. He underwent pars plana vitrectomy during which the membrane tissue on the disc and internal limiting membrane were removed. Posterior vitreous detachment was observed intraoperatively. Thereafter, the tunnel-like lesion observed on OCT was rapidly obscured and the macular schisis gradually reduced. Eighteen months after surgery, his visual acuity had improved to 0.9 with almost complete regression of the macular schisis. No optic disc pit was visualized after surgery. The changes in OCT findings described here suggest an etiology for macular schisis without optic disc pits in an eye with a glaucomatous optic disc with posterior vitreous detachment. A connection between the schisis cavity and the vitreous cavity may have appeared via the tunnel-like structure due to the membrane tissue exerting traction on the optic disc.

Purpose Optic disc pit(ODP) is a rare congenital optic disc abnormality characterized by a localized grayish‐white depression usually in the center or inferotemporal part of the optic nerve head. It is generally unilateral (85‐90%) and its prevalence is estimated to be 1 in 11,000. Unless the ODP develops maculopathy, patients remain asymptomatic. Serous macular detachment may occur in up to 50% of cases, leading to significant decrease in visual acuity. Although the pathogenesis of ODP maculopathy is unclear, various theories about its onset have implicated fluid entry either from the vitreous cavity or from leakage of cerebrospinal fluid through the peripapillary subarachnoid space. The aim of this study was to evaluate the source of subretinal fluid under the macula in a patient with ODPMethods Enhanced depth imaging optical coherence tomography(EDI‐OCT) using the stars scan pattern of the Spectralis HRA + OCT (version 1.5.12.0; Heidelberg Engineering) was usedResults Horizontal SD‐OCT section revealed a small amount of intraretinal fluid in the outer nuclear layer and a prominent serous macular detachment at the same time but with no relationship with either the vitreous cavity or the subarachnoid space. However, a direct communication between the subretinal space and the peripapillary subarachnoid space through the ODP was demonstrated for the first time by using EDI‐OCT.Conclusion This case supports the theory that the source of serous macular detachment in some ODP cases could be cerebrospinal fluid passing into the retina through the ODP due to an incomplete closure of the embryonic fissure

To study the evolution of subretinal precipitates coexistent with optic disc pit (ODP) maculopathy from their appearance at baseline examination until their absorption after successful treatment. Participants in this retrospective, multicenter study were 42 patients with ODP maculopathy, in whom complete ocular examination was performed, including visual acuity (VA) measurement, slit-lamp examination, color or red-free fundus photography, and optical coherence tomography at baseline after surgical treatment. Out of 42 cases, 17 (40.5%) cases of ODP maculopathy, which were examined between 2002 and 2015, were found to have subretinal precipitates associated with multilayer fluid accumulation at baseline. Precipitates were located at the outer part of the photoreceptor layer and remained for 3-6 months after successful treatment and absorption of subretinal fluid. The mean VA was 0.99 ± 0.21 logMAR at baseline and improved to 0.54 ± 0.25 logMAR at the final examination. Macular precipitates in association with signs of disease chronicity, such as multilayer fluid accumulation, became evident at baseline examination. Precipitates' disappearance in 15 out of 17 cases coincided with the absorption of subretinal fluid. The relative low VA at baseline probably could be attributed to the chronicity of the disease.

Pediatric optic disc pit maculopathy (ODPM) is a rare condition that threatens children's visual development. Current treatments, such as pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, are effective but controversial in pediatric cases due to potential complications. The efficacy and safety of ILM-sparing vitrectomy in pediatric ODPM patients remain underexplored. This case series evaluates the outcomes of ILM-sparing vitrectomy in pediatric ODPM patients, providing insights into its potential benefits and complications. This retrospective study included four pediatric patients with ODPM who underwent ILM-sparing vitrectomy. The average patient age was 7.75±3.77 years (range 5-13 years). Preoperatively, all four eyes had retinal detachment involving the central macula. The mean follow-up duration was 29.75±4.57 months (range 25-35 months). Preoperative best-corrected visual acuity (BCVA) was LogMAR 1.18±0.67 (range 0.3-1.7). Twelve months postoperatively, BCVA improved to LogMAR 0.1±0.08 (range 0.1-0.2) and remained stable between 12 and 24 months. Central macular thickness (CMT) also improved from a mean preoperative CMT of 969.75±56.28 to 265.25±34.35 µm at 24 months postoperatively. All four eyes achieved total macular attachment at 12 months postoperatively. Two patients experienced transient postoperative high intraocular pressure, but no recurrent subretinal fluid (SRF) or full-thickness macular holes were observed during follow-up. ILM-sparing vitrectomy appears to be an effective treatment for pediatric ODPM, resolving maculopathies and restoring BCVA with minimal complications. This approach may offer a safer alternative to traditional ILM peeling in pediatric cases. However, larger studies with extended follow-up are needed to confirm these findings and further explore their clinical impact. Optic disc pit; retinal detachment; vitrectomy; pediatric; internal limiting membrane-sparing (ILM-sparing).

The purpose of this study was to present the surgical outcome in optic disc pit associated maculopathy in a patient who was treated with vitrectomy, internal limiting membrane (ILM) peeling, barrage laser photocoagulation, and silicone oil tamponade. A 21-year-old Indian male was diagnosed with optic disc pit maculopathy in his left eye with a best-corrected visual acuity (BCVA) of 20/200. A 23-gauge pars plana vitrectomy with peeling of ILM was done using brilliant blue dye. After completion of vitrectomy, fluid-air exchange was performed and silicone oil was instilled into eye. Peripapillary endolaser barrage photocoagulation using two rows of low-intensity laser was performed temporally. Silicone oil was removed 4 months after surgery. During the next 24 months, the retina gradually flattened with gradual improvement of BCVA in the left eye. At 24 months, fundus examination showed retinal pigment epithelium atrophy temporal to optic disc not involving the fovea, and optical coherence tomography showed complete resolution of subretinal fluid, with a BCVA of 20/60. The patient maintained the same vision 4 years following the surgery. vitrectomy combined with posterior hyaloid and ILM peeling followed by silicone oil tamponade, with additional laser photocoagulation, was successful for the treatment of optic disc pit maculopathy in our patient. Further studies are warranted to explore the various treatment options and try to set a standard treatment protocol for this rare challenging condition.

PurposeTo present rapid and safe closure of the pit-macula communication (PMC) by core vitrectomy and adequate duration gas tamponade as our preferred method of resolving optic disc pit (ODP) maculopathy and to define the term “maculoschisis” in ODP maculopathy as an alternative to the term “schisis-like.”Patient and methodsA twenty-four-year-old female presented with an optical coherence tomography (OCT) confirmed ODP and a “giant” communicating maculoschisis cavity. Central macular thickness (CMT) measured 906 microns, and macular volume was twice normal, at 20.8 mm3. Snellen corrected visual acuity was 20/70. Two months after initial vitrectomy performed elsewhere with short-term gas tamponade (SF6 20%), CMT and visual acuity were not significantly improved. Combined lens extraction/intraocular lens placement and repeat vitrectomy with C3F8 15% gas tamponade were performed, with one supplemental (office) gas injection.ResultsOCT imaging six weeks postoperatively showed definitive closure of the PMC with CMT reduced by 405 microns. Sequestered from its ODP source, foveal schisis fluid then resolved by 12 weeks postoperatively. At final follow-up 3.4 years postoperatively, the macula remained dry with a CMT of 322 microns and a concave foveal contour. Macular volume was reduced to (a normal) 10.2 mm3 and visual acuity had improved to 20/25.ConclusionNo report heretofore has documented rapid, sustained closure of the PMC by gas tamponade as the preferred method of expeditiously resolving ODP maculopathy. However, tamponade PMC closure sequesters ODP fluid and uniquely provides early assurance of ultimate maculopathy resolution. In all other techniques, PMC closure is a trailing phenomenon and success remains uncertain during months to a year or more of (unsequestered) fluid resolution. We suggest that more invasive techniques (laser barrier application to the peripapillary choroid, vitreoretinal interface maneuvers, and pit-plugging) be withheld unless a recurrence is detected during subsequent examinations.

Internal Limiting Membrane Flap and Insertion Techniques Improve Prognosis in Macular Hole-Associated Retinal Detachment.