Abstract
Background: Optic disc pit is a congenital abnormality of the optic nerve head amaculopathy can develop in 25% to 75% of cases and usually confers a poor visual prognosis as a result of a longstanding serous macular detachment, formation of macular hole, and atrophy of the retinal pigmented epithelium. At the moment, there is not a single treatment that is universally accepted. Method: A 65-year-old Caucasian man underwent a complete ophthalmological examination. Results and discussion: Ophthalmoscopic examination and macular Optical Coherence Tomography showed in the right eye an optic disc pit maculopathy complicated by full thickness macular hole. Multifocal-Electroretinogram showed microvolted responses in all the regions. We performed in the right eye a 25 gauge pars plana triamcinolone-assisted vitrectomy with an inverted internal limiting membrane flap inserted both in the macular hole and in the optic disc pit. At 3 months from surgery the patient showed an improvement of macular structure and of visual function as well. Conclusion: We report a case in which a “new” surgical approach was used in a patient affected by optic disc pit maculopathy complicated with a full thickness macular hole. Our technique was effective in improving the maculopathy and leading to an appreciable increase of the visual function; in particular, we found not only a significant improvement of visual acuity, but also of electrophisyological responses, considered by previous studies very sensitive in assessing functional alterations in this disease.
Highlights
Optic disc pit (ODP) is a congenital anomaly of the optic nerve head, unilateral in most of cases, it can be bilateral in 15% of cases; it was first described in 1882 by Wiethe as a gray, whiteyellow or black round depression of the optic disc [1]
We report a case of a new surgical approach used for a patient affected by ODP maculopathy (ODP-M) complicated with a full thickness macular hole (FTMH)
We performed a vitrectomy with posterior hyaloid removal and inverted internal limiting membrane (ILM) flap placed both in the FTMH and in the ODP, 20% SF6 gas tamponade followed by facedown positioning
Summary
Optic disc pit (ODP) is a congenital anomaly of the optic nerve head, unilateral in most of cases, it can be bilateral in 15% of cases; it was first described in 1882 by Wiethe as a gray, whiteyellow or black round depression of the optic disc [1]. Optical coherence tomography (OCT) allowed us to detect ODP-M and to study its morphology It consists of retinoschisis-like separations of the retinal layers followed by the development of a serous macular detachment [8,9,10,11]. Macular Optical Coherence Tomography (OCT) showed in the RE a neuroretinal detachment in the nasal side of the macula, with a FTMH and a coexisting retinal schisis around the lesion and an epiretinal membrane (Figure 1) and in the LE a normal foveal thickness and depression. In the RE at 1 month from surgery the patient had a BCVA of 20/70; the fundus examination and the OCT showed a closure of the FTMH and a reduction in the height of the neuroretinal detachment. MfERG showed a normal signal in the central rings and a subnormal signal in the peripheral rings
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