Pit Maculopathy Research Articles

Efficiency of Laser Treatment of Optic Disc Pit Maculopathy in Children

Efficiency of Laser Treatment of Optic Disc Pit Maculopathy in Children

Management of unresolved optic disc pit maculopathy with human amniotic membrane patch implant: A case report.

Inverted Inner Limiting Membrane (ILM)-flap approach can fail in the treatment of Optic disc pit maculopathy (ODPM). We report a surgical technique involving human amniotic membrane (hAM) patch implant to treat unresolved ODPM after inverted (ILM)-flap technique. One patient with decreased visual acuity (1 LogMar) after unsuccessful inverted ILM-flap technique to treat ODPM, underwent hAM patch implant and was evaluated. A surgical approach including a 2 mm size graft patch of hAM implantation over the optic disc pit followed by fluid-air exchange was performed. A gas endotamponade was finally used. The patient was instructed to maintain face-down position for the first three days after surgery. The hAM patch remained detectable over the pit for the entire 6-months follow-up. The ODPM gradually resolved and visual acuity partially recovered to 0.17 LogMar during follow-up. No postoperative complications or recurrence were reported. hAM patch implant may be effective to manage ODPM after unsuccessful inverted ILM-flap.

Retro-mode imaging of gravitational subretinal fluid associated with optic disc pit maculopathy with extensive retinal schisis in a young myopic patient

A 32-year-old female with high myopia and optic disc pit maculopathy associated with schisis was imaged on the Mirante confocal scanning laser ophthalmoscope (Nidek Co, Ltd, Gamagori, Japan). Scanning laser ophthalmoscope colour fundus photography (A) shows a hypopigmented area corresponding with the schisis (green arrows), whereas the blue-light fundus autofluorescence (B) highlights an oval hyperautofluorescent area consistent with the subretinal fluid (SRF; white arrow), which is a useful landmark to monitor the extension and localization of the fluid during the course of follow-up. Retro-mode illumination (C) demonstrates enhanced visualization of the margin of the SRF (white arrow). The myopic schisis is highlighted on retro-mode illumination (green arrows) as fine radiating lines. Optical coherence tomography demonstrates the schisis associated with subretinal fluid (D). Panel E illustrates more subtle, smaller areas of schisis adjacent to the SRF.

Treating Acquired Optic Disc Pit Maculopathy with an Ocular Hypotensive Agent

Treating Acquired Optic Disc Pit Maculopathy with an Ocular Hypotensive Agent

Isolated sub-internal limiting membrane fluid accumulation as a rare manifestation of optic disc pit maculopathy

Isolated sub-internal limiting membrane fluid accumulation as a rare manifestation of optic disc pit maculopathy

Optic disc pit macular serous detachment recurrence. A surgical approach using ILM autograph

AbstractPurpose: We aim to present a surgical approach for optic disc pit macular serous detachment recurrence, using pars plana vitrectomy (PPV) and internal limiting membrane (ILM) autograft.Methods: Case report – Description of the surgical technique and presentation of the outcome.Results: A 55 year‐old female patient referred to our clinic's Vitreoretinal Department complained of reduced visual acuity at the right eye. On clinical examination, optic disc pit, cystic maculopathy and serous detachment were noted. The patient reported a history of vitrectomy for optic pit macular detachment on the same eye 25 years ago. To manage the recurrent macular detachment, she underwent a vitrectomy, during which the ILM was removed, and part of it used as an autograft on the optic disc pit. Mild endophotocoagulation on the area of the maculopapular bundle was performed, and gas endotamponade was utilized. On follow‐up examinations, a continuous improvement in serous detachment and visual acuity was noted.Conclusions: In cases with recurrent macular serous detachment due to optic disc pit maculopathy, PPV combined with ILM autograft, endophotocoagulation and gas tamponade seems to be a promising technique with satisfactory anatomical and functional improvement.

Surgical management of disc pit maculopathy: A case report

AbstractPurpose: Optic disc pit (ODP) is a rare congenital disorder that affects one in 10 000 people. Serous detachment of macula is the most common complication and the natural history of untreated ODP maculopathy is a gradual deterioration with significant visual loss. A multitude of interventions have been designed for the treatment but none has been established as the treatment of choice. Pars plana vitrectomy is one of the most commonly used procedure in recent years. We present a case report with surgical treatment and management of complications.Methods: An interventional case report of a 63‐year‐old man who attended the emergency room due to sudden visual loss and best corrected visual acuity (BCVA) of 20/200 in the right eye (RE). Upon his arrival, a visual field was performed in which complete abolition of the right field was observed, severely affecting the central area. A papillary pit was found in the eye fundus. Optical coherence tomography (OCT) revealed a serous retinal detachment (RD) with macular involvement and surgical management was decided.Results: A successful pars plana vitrectomy (PPV) with peeling of the internal limiting membrane and application of an endolaser was performed. Three months later, he came back with a higher serous RD and a worsening of BCVA. We performed a second PPV with sulfur hexafluoride (SF6) with good anatomical results. One year later, cataract and an inferior rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) was treated with intraocular lens implantation and PPV with silicone oil. Five months later, supero‐temporal retina was detached, so a new PPV was carried out with silicone oil again. One year later, the silicone oil was removed and a retinal detachment was noted 3 months later. Finally, the last surgery was performed practicing encircling band, PPV, application of endolaser and again using silicone oil.Conclusions: Surgical management of serous retinal detachment caused by papillary pit continues being a challenge for retinal specialists. Complications of surgery are no usually publish in literature and this case report make us take into account. Since it ranges from observation to surgical approach using different techniques and procedures without any showing clear superiority.

Optic nerve disc maculopathy: epidemiology, etiology, pathophysiology, diagnosis, conservative and surgical treatment options (a literature review)

Ieva Kunickaitė1 1Vilnius University, Faculty of Medicine, Vilnius, Lithuania Abstract Introduction. The optic nerve disc (OND) pit is a rare, usually unilateral asymptomatic congenital pathology of the optic nerve disc. 50% of OND pit cases can evolve into macular retinoschisis. OND pit maculopathy is diagnosed by ophthalmoscopy and by optical coherence tomography (OCT) examination, which […]

Natural Course of Optic Disc Pit Maculopathy: An Optical Coherence Tomography Study

Purpose: The aim of this study was to analyze the impact of OCT characteristics on the natural course of optic disc pit maculopathy (ODP-M). Methods: This was a single-center, retrospective, observational case series. Patients with ODP-M were included in the study. Baseline demographic characteristics, central macular thickness (CMT), IPP, subretinal fluid (SRF), subretinal precipitations, outer retinal fluid (ORF), and outer retinal layer hole were evaluated. The changes in the OCT characteristics were analyzed with respect to the best-corrected visual acuity (BCVA) from baseline to the last visit. Results: Twenty-two eyes of 22 patients were evaluated with a mean follow-up time of 37.6 (median 22) months. The mean BCVA was 0.31 logMAR at baseline and 0.28 logMAR at the final visit (p = 0.521). Baseline BCVA was significantly related to CMT (β coefficient 0.001, p = 0.002). Mean BCVA increased in 7 patients (group 1), remained stable in nine (group 2), and decreased (group 3) in 6 patients. No significant difference was found between the groups regarding the baseline BCVA, CMT, and extent of retinal fluid. In patients with subretinal deposits, BCVA remained stable in 3 patients and worsened in one. ORF was recorded in all patients. In patients with SRF, the mean change of BCVA during follow-up differed significantly, depending on the presence (0.07 logMAR) or absence (−0.125 logMAR) of SRF (p = 0.019). Conclusion: Among the OCT characteristics, SRF was a negative prognostic factor in ODP-M. Most ODP-M patients showed improved or stable vision over 3 years of follow-up. Therefore, observation may be considered in patients with reasonable vision and without SRF even when they present with remarkable OCT findings.

This issue of ACTA

This issue of ACTA

Double trouble: Optic disc pit maculopathy in advanced glaucoma.

Double trouble: Optic disc pit maculopathy in advanced glaucoma.

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.

Clinical features, treatment factors, and long-term outcomes of optic disc pit maculopathy.

To assess the clinical features, treatment factors, and long-term visual and anatomical outcomes of optic disc pit maculopathy (ODPM) in Korean patients. Consecutive patients diagnosed between January 2000 and September 2020 were retrospectively reviewed. The primary outcome was best-corrected visual acuity (BCVA) and anatomical changes (determined by macular thickness reduction and fluid resorption). Secondary outcomes included factors associated with poor visual outcomes (> 3-line decrease or < 20/200 vision). Of the 24 eyes (24 patients, mean age, 42.8years) in this study, two peak incidence groups were noted: children younger than 14years (six patients; mean age, 9.7years) and middle-aged adults (18 patients; 53.8years). There were no significant differences between groups in terms of clinical features, treatment, and outcomes (P > 0.05). The primary treatment involved immediate (7 eyes) or delayed (9) vitrectomy, laser only (2), or observation only (6). Good (50%) or partial (33%) anatomical response was noted in most cases at the final follow-up (P > 0.05). However, regression analyses showed that poor visual outcomes were associated with low preoperative BCVA (OR, 8.73; 95%CI, 1.34-56.85; P = 0.023) and delayed vitrectomy (OR, 13.00; 95%CI, 1.70-99.38; P = 0.013), while presence of intraretinal fluid in the inner and outer layers reduced the risk (OR, 0.086; 95%CI, 0.01-0.88; P = 0.039). Patients with ODPM may have two peak incidence groups with similar clinical features and treatment outcomes, supporting the idea of heterogeneous mechanisms triggering fluid accumulation. Although the primary treatment choice may not impact long-term anatomical outcomes, delayed vitrectomy may be associated with poorer visual outcomes.

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.

Optic Disk Pit Maculopathy Treatment Using a Human Amniotic Membrane Patch: One-Year Results

To report the 1-year results of human amniotic membrane patch implantation for optic disc pit maculopathy. A prospective, consecutive, interventional study. Eleven eyes of 11 patients affected by optic disc pit maculopathy associated with subretinal/intraretinal fluid were included in this single-institution study. A 25-gauge pars plana vitrectomy was performed in all cases, with an implant of a human amniotic membrane patch into the optic disc pit and air was injected as endotamponade. The primary study outcome was the subretinal and intraretinal fluid reabsorption. Secondary outcomes were visual acuity improvement and postoperative complications. Mean central retinal thickness gradually diminished from 512 ± 137 µm to 243 ± 19 µm, at the 12-month follow-up. The mean visual acuity improved from 20/80 at baseline to 20/32 at the 12-month follow-up. Complete fluid resorption occurred in 9 of 11 (81.8%) eyes and there was partial resorption in 2 eyes (18%). No subretinal fluid recurrence was observed during the 12-month follow-up. No intraoperative or postoperative complications were reported during the follow-ups. The amniotic membrane patch remained detectable inside the pit for the entire follow-up time. An amniotic membrane plug may be effective for improving optic disc pit maculopathy. All cases had an anatomical improvement and encouraging visual acuity recovery.

The outcomes of intravitreal C3F8 gas tamponade combined with laser photocoagulation treatment for optic disc pit maculopathy.

PurposeTo share the anatomical results and visual outcomes of intravitreal gas tamponade combined with laser photocoagulation treatment for optic disc pit maculopathy (ODPM). MethodsIntravitreal gas tamponade combined with laser photocoagulation treatment was performed on six consecutive patients with ODPM. A 0.3 mL of 100% perfluoropropane (C3F8) gas was injected intravitreally. The patients were then asked to maintain prone position until the C3F8 gas disappeared. Laser photocoagulation was performed the day after the procedure. The outcomes were determined by spectral-domain optical coherence tomography and best-corrected visual acuity (BCVA).ResultsIn the present study, visual improvement and reduction in serous macular detachment were observed in 83% of the ODPM patients. Complete retinal reattachment was achieved in 66% of the ODPM patients. In one patient, no regression was observed after the repeated treatment, and pars plana vitrectomy was performed. The final BCVA improved in five eyes and unchanged in one eye. No postoperative complications were observed during the follow-up period in any patient.ConclusionsIntravitreal C3F8 gas tamponade combined with laser photocoagulation procedure is an effective, minimally invasive, and cost-effective treatment method for ODPM.

Optyczna koherentna tomografia w diagnostyce dołka rozwojowego nerwu wzrokowego – przegląd piśmiennictwa

Optyczna koherentna tomografia w diagnostyce dołka rozwojowego nerwu wzrokowego – przegląd piśmiennictwa

Management of optic disc pit maculopathy: the European VitreoRetinal society optic pit study.

To evaluate a variety of techniques, and their anatomical and functional results, for the treatment of optic disc pit maculopathy (ODP-M). A secondary aim was to report on results of secondary procedures in cases of initial failure or recurrence. Multicentre retrospective study of 95 eyes with ODP-M, treated by 25 surgeons from 12 countries. Primary outcomes were anatomical resolution of subretinal fluid (SRF), intraretinal fluid (IRF) and visual acuity (VA) at 12 months. Higher rates of SRF and IRF resorption were achieved in eyes treated with pars plana vitrectomy (PPV) compared to external laser with or without tamponade: 64/72 (88.9%) versus 8/14 (57.1%) for SRF (p = 0.003), and 50/59 (84.7%) versus 3/10 (30%) for IRF (p = 0.002). The addition of juxtapapillary laser or internal limiting membrane (ILM) peel during PPV did not improve SRF or IRF resolution. Pars plana vitrectomy (PPV) with tamponade and PPV with tamponade plus endolaser were associated with significant visual gain. In the former group, VA improved from a mean of logMAR 0.91 (20/162), to a mean of logMAR 0.52 (20/66) at 12 months; in the latter group, VA improved from a mean of logMAR 0.82 (20/132) to a mean of logMAR 0.47 (20/59) at 12 months. Retreatments were performed in 14 eyes (15.7%), only enhancing anatomical outcomes. Vitrectomy with tamponade had better final outcomes than external laser treatment with or without gas tamponade. Laser endophotocoagulation and ILM peel provided no additional benefit. A secondary treatment resulted in anatomical but not functional improvement.

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.

Inner retinal fenestration for paediatric optic disc pit maculopathy: a case series.

To evaluate the efficacy of inner retinal fenestration as a surgical technique for the treatment of optic disc pit maculopathy (ODPM) in the paediatric population. This is a retrospective, interventional case series of paediatric patients with ODPM treated at two tertiary hospitals in London by a single surgeon (SCW). All patients underwent pars plana vitrectomy with the creation of two inner retinal fenestrations and endogas tamponade. The partial-thickness retinotomies were made radial to the optic disc pit using a 25-gauge MVR blade. Anatomic and visual outcomes were determined by optical coherence tomography central retinal thickness and best-corrected visual acuity (BCVA), respectively. A total of six eyes were included. Average patient age was 12.0 ± 3.5 years. Preoperatively all eyes demonstrated intraretinal fluid and/or serous detachment of the central macula. Patients were followed for a mean of 22.7 ± 16.1 months after surgery. Mean preoperative BCVA was logMAR 0.71 ± 0.29 (20/100). Mean postoperative BCVA was 0.49 ± 0.30 (20/63) at 2 weeks, 0.35 ± 0.33 (20/45) at 3 months and 0.16 ± 0.29 (20/32) at 1 year. Progressive resolution of intraretinal and subretinal fluid (SRF) was observed in all eyes, with central retinal thickness significantly improved by 2 weeks postoperatively (637.83 ± 209.09 µm preoperatively and 465.40 ± 169.86 µm postoperatively, p = 0.04). Recurrence of subretinal or intraretinal fluid was not observed. Dual inner retinal fenestration is an effective technique that resolves fluid and restores vision in paediatric patients with ODPM. These results support the hypothesis that enabling egress of fluid into the vitreous cavity can achieve long-lasting amelioration of ODPM.