Optic Pit Maculopathy Research Articles

Choroid Involvement Secondary to Optic Disc Pit Maculopathy: OCT Analysis And Evolution After Surgical Treatment: Choroidal Involvement In Optic Pit Maculopathy

PurposeTo assess choroidal changes associated to optic disc pit maculopathy (ODP-M) and their evolution after surgical treatment. DesignMulticentric retrospective case series. MethodsAnalysis of 42 patients affected by unilateral ODP-M undergoing surgical treatment between 2013 and 2023. Optical coherence tomography (OCT) were performed at baseline and postoperative months 1, 6, 12, 24 and most recent follow-up. Subfoveal choroidal thickness (SFCT) and peripapillary choroidal thickness (PPCT) were measured in ODP-M and fellow eyes. The presence of retinal pigmented epithelium (RPE) atrophy was used to distinguish between “early” and “advanced” disease, and data regarding fluid localization were collected. ResultsBaseline SFCT in ODP-M eyes was significantly higher than fellow eyes (386.8±88.9 vs. 334.4±72.2 μm, p=0.002), differently from PPCT (192.6±47.8 vs. 181.2±45.7 μm, p=0.46). SFCT significantly decreased 1 month post-operatively (mean reduction 36.5 μm, p=0.009) and remained below pre-operative values throughout the follow-up, showed a mean reduction of 79.4 μm at final follow-up (p<0.001). Conversely, PPCT showed no changes between pre-operative and post-operative values (all p>0.05). Nine eyes (21.4%) showed submacular dilated choroidal vessels, correlated with the presence of subretinal fluid (p=0.008) and reducing in caliber after surgical treatment. The 10 eyes (23.8%) with “advanced” disease had lower baseline SFCT and worse BCVA compared to the “early” subgroup, and showed a delayed reduction of choroidal swelling post-operatively. ConclusionSubfoveal choroid may thicken and remodel in response to ODP-M, eventually returning to physiological values after surgical treatment. Moreover, the presence of RPE atrophy may influence retino-choroidal balance. Conversely, PPCT didn't show comparable modifications.

Double flaps of internal limiting membrane for chronic optic pit maculopathy with large outer lamellar hole

A 24-year-old woman presented with very chronic optic pit maculopathy and outer lamellar hole. During vitrectomy, two internal limiting membrane (ILM) flaps were designed and inverted from the temporal to the nasal side to cover the thin-roofed fovea and the optic pit. Two weeks post vitrectomy, the outer lamellar hole de-roofed into a full-thickness macular hole but remained covered with the inverted ILM flap. The hole edges grew centripetally and re-bridged over the next month. By 9 months, the macular hole had closed, schisis settled, and BCVA improved substantially.

Optic pit maculopathy: incidence and clinical course

The aim of this case series was to investigate the clinical course of patients with optic pit maculopathy. The medical records of all patients diagnosed with optic pit maculopathy in the past 10years were reviewed. Optic pit maculopathy was diagnosed when localized intraretinal or/and subretinal fluid spread from the optic nerve to the macula. Outcome measures included changes in best corrected visual acuity (BCVA), central retinal thickness (RT) as well as nasal parafoveal and perifoveal RT. An optic disc pit was detected in 18patients (9female, 9male, mean age: 33 ± 23years). Retinal fluid accumulation was present in 6(33.3%) of the patients (1intraretinal, 1subretinal, 4intraretinal and subretinal). Pars plana vitrectomy with removal of peripapillary vitreous traction and peeling of the internal limiting membrane (ILM) was indicated in 5patients and was performed in 4patients. One patient underwent nanopulse laser treatment instead. The patients with optic pit maculopathy were 47 ± 16years old. In this group of patients, mean BCVA (decimal) improved from 0.3 ± 0.2 before treatment to 0.5 ± 0.2 3months after treatment (p = 0.03). Visual acuity improved in all patients with optic disc pit maculopathy after pars plana vitrectomy. The mean central RT decreased from 796 ± 214 before treatment to 324 ± 57 3months after treatment (p = 0.005). The mean nasal parafoveal RT decreased from 683 ± 87 before treatment to 372 ± 41 (p = 0.0003) and the mean nasal perifoveal RT decreased from 547 ± 89 before treatment to 360 ± 48 (p = 0.007). Acompletely dry macula was achieved in 4eyes after amean follow-up of 3months. At long-term follow-up (2.5 ± 1.2years), no recurrence occurred in the vitrectomized eyes. This case series showed that more than one third of the patients had optic pit maculopathy presumably caused by disruption of the Kuhnt intermediate tissue. Interventional treatment was indicated in all cases, of which 4were surgically treated and resulted in significant improvement of function and anatomical retinal structures.

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.

Current advances in the management of optic disc pit maculopathy

ABSTRACT Introduction Although we have been familiar with optic disc pits for a long time, the diagnosis and management of maculopathy remain unclear. Better imaging has improved the diagnosis of this subtle pathology. A recent update on the natural history of optic pit maculopathy marks a paradigm shift in the understanding and management of this condition. There is renewed scope for non-surgical management and less urgency for vitrectomy, which remains the definitive treatment. Areas covered This perspective highlights and critiques the updates on diagnostic imaging, natural history, indications and prognosis for surgery, non-surgical alternatives, and surgical adjuncts. We searched the Medline database using the keywords optic pit AND maculopathy, optic pit AND macular schisis, optic pit AND macular detachment; optic pit AND vitrectomy, optic pit AND laser photocoagulation, and included the salient articles. Expert commentary There has been no major change in the surgical options and outcomes for optic pit maculopathy in recent times, except a greater clarity on the role of vitrectomy without any adjuvants as the primary surgical procedure. The key updates are on better imaging for diagnosis and prognosis, and less urgency for surgery in view of the favorable natural history.

In vivo generated autologous plasmin assisted vitrectomy in young patients

BackgroundAutologous plasmin enzyme facilitates the induction of posterior vitreous detachment(PVD) during vitrectomy in young patients. We proposed the concept of in-vivo generated plasmin which is based on the injection of tissue plasminogen activator(t-PA) and autologous whole blood(AWB) into the vitreous cavity. The purpose of this pilot study is to report the efficacy of preoperative simultaneous intravitreal injection of(t-PA) and autologous whole blood in facilitating the intraoperative induction of PVD in young patients with various vitreoretinal pathologies.MethodsSeventeen eyes of 16 young patients with various vitreoretinal pathologies requiring vitrectomy, who received simultaneous intravitreal injection of 0.1 ml of AWB and 25 µg of t-PA, 3 days prior to surgery were retrospectively reviewed. Outcome measures were the number of attempts required to achieve successful intraoperative separation of the posterior hyaloid; the postoperative visual acuity; and intraoperative and postoperative complications.ResultsThe mean age of the patients was 23.87 ± 10.09 years, ranging from 10 to 39 years. Eight of 16 patients were men. The mean follow-up time was 19.35 ± 5.04 months, ranging from 12 to 26 months. Surgical indications for vitrectomy were chronic retinal detachment (n = 7), traumatic retinal detachment without proliferative vitreoretinopathy(n = 3), traumatic macular hole(n = 1), secondary vasoproliferative tumor(n = 4) and optic pit maculopathy(n = 2). Patients with retinal detachment complicated with PVR and those who were older than 40 years of age were excluded from the study. Separation of the Weiss ring from the optic nerve head was achieved intraoperatively in all cases, with a mean number of 2.86 ± 1.4 attempts. While the mean preoperative LogMAR visual acuity was 1.38 ± 0.59, ranging from 2.40 to 0.50, it was a mean of 0.51 ± 0.29, ranging from 1.00 to 0.10 at final postoperative exam(p < 0.001; paired samples t-test). No preoperative or intraoperative complications were noted.ConclusionPreoperative simultaneous intravitreal injection of 25 µg t-PA with 0.1 ml of AWB facilitates the intraoperative induction of posterior vitreous detachment in young patients.

Stellate nonhereditary idiopathic foveomacular retinoschisis and an approach to the differential diagnosis of macular star.

This review aims to introduce stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) and its differential diagnosis. We summarize findings from case reports and series published in the last few years on the clinical and imaging findings in SNIFR. SNIFR presents as either a unilateral or bilateral macular star on fundus examination without clinical or imaging evidence of exudation or frank vitreomacular traction. optical coherence tomography (OCT) imaging shows schisis cavities in the Henle fibre and outer plexiform layers that correspond to the stellate en face findings. Visual acuity is usually minimally affected, and the presence of significant vision loss should prompt high clinical suspicion for alternate diagnoses. SNIFR is a recently characterized clinical entity that serves as an important addition to the differential diagnosis of a macular star. It is a diagnosis of exclusion and should be distinguished from other causes of macular star such as neuroretinitis, vitreomacular traction, ocular manifestations of malignant hypertension, congenital juvenile X-linked macular schisis, myopic maculopathy, optic pit maculopathy, nicotinic acid maculopathy or taxane maculopathy among others.

A Patient With Optic Nerve Pit Maculopathy Successfully Treated With Juxtapapillary Laser Photocoagulation

Optic disc pits are rare and congenital or acquired anomalies of the optic disc, usually remaining asymptomatic. However, serous macular detachment or optic disc maculopathy is the most common complication, causing significant visual deterioration, without a current consensus about treatment. A 55-year-old woman with a past medical history of diabetes mellitus and systemic hypertension was referred for an abnormal finding in the retina. The Corrected Distance Visual Acuity (CDVA) was 20/40 in the right eye and 20/30 in the left eye. Marcus-Gunn was negative and Slit-lamp biomicroscopy revealed no pathologic findings in both eyes. Funduscopic examination showed an excavation in the inferotemporal part of the Optic Nerve Head (ONH) with serous macular detachment extending to the optic disc. Based on clinical examination and paraclinical imaging fluorescein Angiogeraphy (FAG) Optical Coherence Tomography (OCT), optic pit maculopathy was diagnosed and the patient underwent Juxtapapillary Laser Photocoagulation (JLP). After 2 years of follow-up, there were anatomical and functional improvements.

Optic Pit Maculopathy: Clinical Features and Management Options.

In this article, we review the pathogenesis, clinical features, imaging modalities and latest management options for optic pit maculopathy (OPM). The pathogenesis of OPM remains to be unclear, but imaging tools such as optical coherence tomography (OCT) and OCT angiography are enhancing our knowledge. Observation continues to be the best management strategy for patients with good visual acuity, and many cases have demonstrated spontaneous resolution. For more advanced, progressive vision loss, treatment options involving vitrectomy can be considered and discussed with the patient. Supplementary techniques to vitrectomy have been reported in small studies with relative success such as glial tissue peeling, inverted internal limiting membrane flap, optic pit plugging, and retinal fenestration. While there are multiple treatment options available for OPM, there is no consensus on the technique and surgical timing. Individual patient factors and the risks-benefits of treatment must be taken into account in guiding management. Larger clinical trials will further assist in decision making for treating OPM.

Vital dyes in macular hole surgery.

Currently, surgical techniques, such as internal limiting membrane peeling, are used widely for macular holes, macular puckers, epiretinal membranes, diabetic macular edema, retinal detachment, retinal vein occlusions, vitreomacular traction, optic pit maculopathy, and Terson syndrome. This study aimed to highlight any differences regarding visual acuity and ocular tomography coherence changes after staining the internal limiting membrane with dilutions of Brilliant Blue G vs. lutein/zeaxanthin-based dyes. This study involved 30 eyes of 30 patients who had undergone posterior pole vitrectomy for idiopathic stage 4 macular hole. The study lot was divided in two subgroups, 15 eyes colored with Brilliant Blue and the other 15 eyes colored with lutein and zeaxanthin dyes. The association between visual prognosis, ocular tomography coherence changes and intraocular pressure was analyzed. The surgical treatment with required endoillumination levels and a 2-min period of dye using the Alcon Constellation Vision System had no negative impact on cell viability and improved visual acuity by 30%. Staining makes it easier to remove, to be quick and precise while performing macular surgeries. In has been observed that lutein and zeaxanthin dyes offer an intraoperative protective screen that protects photoreceptors more than Brilliant Blue while performing pars plana vitrectomy. Both study groups had good results in time. Surgical visualization is an evolving technology.

Optic nerve pit maculopathy worsened during pregnancy: a case report

BackgroundTo report a case of Optic Disc Pit (ODP) maculopathy exacerbated during pregnancy.Case presentationA 30-year-old female developed unilateral blurry vision at 10-weeks gestation. Ophthalmic examination revealed left eye reduced visual acuity (VA) with the presence of subretinal fluid temporal to the disc extending to the fovea. On Spectral Domain Optical Coherence Tomography (SD-OCT) subretinal, and intraretinal fluid was confirmed. Laser photocoagulation was tried in an attempt to prevent surgical intervention without success; subsequently, pars plana vitrectomy, internal limiting membrane peel and gas tamponade was performed. Three-weeks later, a full thickness macular hole developed, and repeat surgery was performed. Nine-months after the second surgery the macular hole was closed with near complete resorption of edema.ConclusionsNo trigger factors for ODP maculopathy have been reported before. We report a case of worsening ODP maculopathy during pregnancy with good visual outcome after surgical intervention.

Surgical technique: Autologous scleral flap for optic disk pit maculopathy.

To present a clinical case and surgical technique for management of optic disk pit (ODP) maculopathy. Surgical technique video of lens sparring pars plana vitrectomy, autologous scleral flap insertion and gas tamponade. After 1 year follow-up visual acuity was restored to 20/25, retinal serous detachment and schisis were resolved and the autologous scleral flap remained in the (ODP). In this case, treatment with pars plana vitrectomy autologous scleral flap insertion and gas tamponade for optic pit maculopathy provided satisfactory anatomical and functional results.

Surgical Options and Outcomes in the Treatment of Optic Pit Maculopathy: A Meta-analysis and Systematic Review

Optic pit maculopathy (OPM) is an uncommon cause of vision loss with no standard surgical treatment. Surgical treatment involves pars plana vitrectomy (PPV), often combined with adjunctive procedures. Large studies comparing outcomes of these approaches are lacking because of low disease incidence. Therefore, we conducted a meta-analysis of PPV without or with adjunctive procedures. Meta-analysis and systematic literature review. We conducted a literature search to identify clinical studies and case series of surgically managed OPM. Inclusion criteria were: (1) more than 2 patients, (2) treatment with PPV, and (3) reporting of preoperative and postoperative visual acuity data. We excluded review articles and studies not available in English. Results were analyzed using a 1-way analysis of variance, Pearson's chi-square test, and simple linear regression. Publication bias was modeled using funnel plots. Visual acuity changes, resolution rate, resolution time, and change in OCT thickness. We identified 26 studies, encompassing 27 years and 342 patients. We identified 6 commonly reported techniques: PPV alone (92 patients), PPV plus juxtapapillary laser treatment (JPL; 146 patients), PPV plus internal limiting membrane peeling (ILMP; 50 patients), PPV plus both ILMP and JPL (16 patients), PPV plus inner retinal fenestration (18 patients), and PPV plus autologous platelet concentrate (22 patients). All groups demonstrated improved best-corrected visual acuity (BCVA; average, 0.46 logarithm of the minimum angle of resolution [logMAR]; 95% confidence interval [CI], 0.41-0.51 logMAR) compared with baseline, with no differences between groups (P= 0.11). The average OPM resolution rate was 70% among all groups (range, 56%-100%), and the average time to resolution was 8.4 months for all groups (95% CI, 7.2-9.6 months). Central macular thickness was reduced in all groups with no differences between groups (P= 0.15). Tamponade had no effect on outcomes. Linear regression analysis demonstrated significant correlations between preoperative BCVA and above outcome measures. Funnel plots demonstrated positive publication bias in PPV and PPV plus JPL groups. We did not identify any significant differences in outcomes among 6 different surgical techniques. This study is limited by its inclusion of primarily retrospective studies and positive publication bias.

Incidence and Evolution of Subretinal Precipitates in Optic Disc Pit Maculopathy.

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.

VITRECTOMY FOR MACULAR RETINOSCHISIS WITHOUT A DETECTABLE OPTIC DISK PIT.

To evaluate the efficacy of vitrectomy in the treatment of macular retinoschisis without a detectable optic disk pit. This retrospective interventional case series included eight patients with acquired, unilateral macular retinoschisis with or without foveal detachment. Patients with an optic disk pit, vitreomacular traction, or high myopia were excluded. Six of the eight patients underwent vitrectomy with internal limiting membrane peeling and fluid-air exchange. The surgical outcome was evaluated in terms of the improvement in the macular anatomy and the best-corrected visual acuity. During vitrectomy, all the six eyes were confirmed to have preexisting posterior vitreous detachment. Macular retinoschisis was resolved or reduced in all the six eyes after vitrectomy. The mean central foveal thickness showed significant improvement at the time of the patient's final visit after vitrectomy. The mean best-corrected visual acuity was 20/52 before surgery and 20/31 at the final visit. Vitrectomy might be effective for the treatment of macular retinoschisis without an optic disk pit. Although clinically similar to optic pit maculopathy except for the absence of pit, our intraoperative observations of the posterior hyaloid membrane suggest that maculopathy without optic disk pit has a distinct pathogenesis.

Spontaneous Regression of Optic Disc Pit Maculopathy in a Six-Year-Old Child

A 6-year-old boy with a complaint of blurred vision for two months was referred to our clinic. His visual acuity was 20/32 in the right eye and 20/20 in the left eye. Optical coherence tomography (OCT) revealed optic disc pit maculopathy in the right eye. The patient was followed for 6 months without any treatment. At the end of the 6-month period, the patient’s visual acuity was 20/20 in both eyes. The OCT imaging showed spontaneous regression of the optic disc pit maculopathy. In this case report, it is concluded that in children, spontaneous regression of the optic pit maculopathy with full recovery of visual acuity is possible. The development of optic pit maculopathy in childhood is rare and there are not enough studies on the treatment methods. Therefore, our case report may be helpful in the management of similar cases of pediatric optic disc maculopathy.

Optic Pit Maculopathy

This paper discusses a 32-year-old woman's case who presented a chronic decrease of visual acuity. In this case, the treatment was complex and consisted of a 25 GA vitrectomy, MLI peeling, covering the defect at the optic nerve papilla with that patch, gas endotamponade (C3F8). Abbreviations: MLI = internal limiting membrane; ODP-M = optic disc pit maculopathy.

Surgical management of optic pit maculopathy: controversies and caveats

ABSTRACTIntroduction: We know with reasonable clarity that the natural course of optic disc maculopathy is poor and laser photocoagulation alone fails to improve outcomes. Surgical management is therefore favored for most cases; optimum surgical treatment however remains controversial. This perspective attempts to evolve consensus from the evidence strewn in the literature, and proposes a rational management protocol.Areas covered: The literature on management of optic pit maculopathy leans towards vitrectomy, with or without additional procedures like laser photocoagulation, internal limiting membrane peeling and intraocular gas tamponade, though excellent outcomes have been reported with posterior scleral buckling. The authors conducted a search of the Medline database for all years using the keywords optic pit maculopathy, optic pit AND macular schisis, optic pit AND macular detachment; optic pit AND vitrectomy, optic pit AND laser photocoagulation, and included the pertinent articles.Expert commentary: While prospective randomized trials are probably not possible due to rarity of the condition, the minimal intervention which affords maximum outcomes appears to be vitrectomy and induction of posterior vitreous detachment: the quintessential first line of treatment. Any additional procedures should be kept in reserve for 6–12 months to allow for the slow anatomical and functional recovery.

Full-Thickness Macular Hole Formation after Internal Limiting Membrane Peeling: Beware the "Omega Sign".

Purpose. To introduce a clinical sign on spectral domain optical coherence tomography (SDOCT), which may indicate high risk for full-thickness macular hole formation after internal limiting membrane (ILM) peeling. Methods. The preoperative SDOCT images of two patients—one with multilaminar hemorrhage from ruptured retinal artery macroaneurysm and one with serous retinal detachment and severe macular schisis from optic pit maculopathy—who developed full-thickness macular hole (FTMH) after ILM peeling were evaluated retrospectively. Results. On the preoperative SDOCT images of both patients there was a thin bridge of tissue on either side of the foveal center with an outer retinal defect. The photoreceptors were displaced laterally away from the foveal center to create an “omega-” shaped configuration of the remaining tissue. Conclusion. “Omega-” shaped configuration on SDOCT may represent a higher risk of FTMH following ILM peeling. Vitreoretinal surgeons may wish to consider this sign in the process of their surgical decision making.

A Surgical Technique for Optic Pit Maculopathy: Vitrectomy Combined with Reversed ILM flap

A Surgical Technique for Optic Pit Maculopathy: Vitrectomy Combined with Reversed ILM flap