Surgical approach to optic disc pit maculopathy.

Abstract

PURPOSE

To evaluate postoperative results of pars plana vitrectomy combined with an inverted ILM-flap technique for optic disc pit maculopathy (ODP-M) complicated by serous macular detachment.

SETTING / VENUE

The Department of Retina and Vitreous Pathology of SI «The Filatov Institute of Eye Diseases and Tissue Therapy of NAMS of Ukraine»

METHODS

An 11-year-old girl presented with a three-month history of decreased vision in her left eye. The patient underwent an eye examination, including best-corrected visual acuity (BCVA) testing, slit-lamp biomicroscopy, dilated fundus examination, intraocular pressure (IOP) measurement, spectral-domain optical coherence tomography (SD-OCT) and color fundus photography. BCVA in the left eye was 20/50 (0.4). Preoperative OCT findings showed distortion of retinal layers, serous macular detachment and a large schisis cavity in the left eye. Foveolar depression was not determined due to the height of intraretinal fluid (IRF) and subretinal fluid (SRF) extending towards the ODP. Retinal thickness in the macular area was 507 μm. Pars plana vitrectomy (PPV) was performed in combination with an inverted internal limiting membrane (ILM)-flap technique, followed by 15% C3F8 gas endotamponade in order to prevent subretinal fluid migration and subsequent detachment of macula. Viscoelastic material was injected in the vitreous cavity prior to fluid-air exchange to prevent ILM-flap displacement. A patient was instructed to maintain a face-down position for two weeks after the surgery. Based on the anatomical (subretinal fluid resorption, macular reattachment) and functional (BCVA) data, as well as the presence of postoperative complications, treatment efficacy was evaluated. The follow-up period was three months.

RESULTS

There were no complications during the surgery and the early postoperative period. The ILM flap was formed according to the above procedure and fixed with a viscoelastic material, which prevented from its displacement during the fluid-air exchange. Intravitreal gas injection of 15% perfluoropropane was performed to achieve macular reattachment. The volume of the intraocular gas bubble was 85% and 70% in the early postoperative period and at the time of discharge, respectively; IOP was 15-16 mmHg. A follow-up OCT examination in 3 months showed decreased subretinal fluid, residual edema, and restored foveolar depression. Retinal thickness in the macular area was 328 μm BCVA of the left eye improved to 20/32 (0.63). In addition, OCT scans determined a significant reduction in central macular thickness in all sectors.

CONCLUSIONS

PPV with an inverted ILM-flap technique for ODP-M allowed to reduce retinal edema, and the visco-associated flap fixation technique created conditions for its stabilization, which ultimately contributed to improving anatomical and functional outcomes during surgery and in the postoperative period.