Abstract
Purpose: To describe how Swept Source Optical Coherence Tomography (SS-OCT) provides enhanced diagnostic information enabling optimisation of surgical strategy in a pediatric patient suffering from ODP maculopathy. We report the first case of successful management of ODP maculopathy via pars plana vitrectomy (PPV) and air tamponade. Methods: Interventional case report. Results: A five-year-old girl presented with ODP and serous macular detachment in her previously amblyopic left eye. SS-OCT showed optically opaque vitreous fibres perpendicularly attached to the base of the optic nerve head excavation and what appeared to be fibrous tissue at the base of the excavation of the optic nerve head and attached to the pit. Detachment of the posterior hyaloid was induced during PPV, the pre-optic nerve head fibrosis was removed with forceps and fluid/air exchange was carried out to induce air tamponade. The serous macular detachment had resolved 11 months after the surgery and the optic pit was reduced in size. No maculopathy recurrences or complications such as cataract were observed. Best corrected visual acuity did not improve possibly because of pre-existing amblyopia. Conclusion: SS-OCT demonstrated anatomical features not previously described in ODP maculopathy and could assist in the choice of surgical technique. In patients with ODP maculopathy and documented optic nerve head vitreous attachment with peri-pit fibrosis, vitrectomy supplemented by tamponade with air alone may be a viable alternative to tamponade with gas with or without laser photocoagulation. This modified technique may reduce the risk of complications such as cataract formation.
Highlights
Optic Disc Pit (ODP) is a rare condition occurring in approximately 1 in 10,000 of the population
We report a case of ODP maculopathy treated with pars plana vitrectomy surgery (PPV) and air tamponade without internal layer membrane (ILM) peel or laser photocoagulation
Swept-Source Optical Coherence Tomography (SS-OCT) allowed the visualisation of vitreous fibres and fibrous tissue attached to the optic nerve head and optic pit and led us to adopt a less complicated surgical approach to the management of this case
Summary
Optic Disc Pit (ODP) is a rare condition occurring in approximately 1 in 10,000 of the population. Serous macular detachment occurs in up to 50% of all cases. The most widely accepted treatment for this condition is pars plana vitrectomy surgery (PPV) with or without internal layer membrane (ILM) peeling, gas tamponade and retinal laser photocoagulation. Improvements in Optical Coherence Tomography (OCT) imaging are helping clinicians to better understand ODP maculopathy. We report a case of ODP maculopathy treated with PPV and air tamponade without ILM peel or laser photocoagulation. Swept-Source Optical Coherence Tomography (SS-OCT) allowed the visualisation of vitreous fibres and fibrous tissue attached to the optic nerve head and optic pit and led us to adopt a less complicated surgical approach to the management of this case
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