Long-term Clinical Outcome of Vitrectomy for the Treatment of Optic Disc Pit Maculopathy

Jong Ho Park; Sung Who Park; Ji Eun Lee; Ik Soo Byon

doi:10.3341/jkos.2019.60.4.340

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Park, Park, Lee, and Byon: Long-term Clinical Outcome of Vitrectomy for the Treatment of Optic Disc Pit Maculopathy

Original Article

Journal of the Korean Ophthalmological Society 2019; 60(4): 340-347.

Published online: 17 April 2019

DOI: https://doi.org/10.3341/jkos.2019.60.4.340

Long-term Clinical Outcome of Vitrectomy for the Treatment of Optic Disc Pit Maculopathy

Jong Ho Park, MD^1,², Sung Who Park, MD^3,^4,⁵, Ji Eun Lee, MD, PhD^3,^4,⁵, Ik Soo Byon, MD, PhD^1,^2,⁵

¹Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea.

²Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.

³Department of Ophthalmology, Pusan National University Hospital, Busan, Korea.

⁴Medical Research Institute, Pusan National University Hospital, Busan, Korea.

⁵Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea.

Address reprint requests to Ik Soo Byon, MD, PhD. Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, #20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea. Tel: 82-55-360-2592, Fax: 82-55-360-2161, isbyon@pusan.ac.kr

Received 6 September 2018 Revised 21 September 2018 Accepted 18 March 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the long-term outcomes of optic disc pit maculopathy after vitrectomy.

Methods

We evaluated retrospectively the medical records of eight patients with macular retinal detachment or retinoschisis who underwent vitrectomy due to optic disc pit maculopathy. The best-corrected visual acuity and optical coherence tomography findings were analyzed after surgery.

Results

Eight eyes of eight patients (two male and six female) were enrolled. The mean best-corrected visual acuity was 0.76 log MAR, the mean age was 42.8, and the mean follow-up period was 56 months (range: 8–120 months). At baseline, retinoschisis was observed in all eight eyes. Six eyes had serous retinal detachment of the macula. Vitrectomy for a complete posterior vitreous detachment was performed. Additional internal limiting membrane peeling and tamponade were performed in six and four eyes, respectively. After surgery, serous retinal detachment was gone in all eyes (100%) at a mean of 22.8 months (range: 18 days–60 months). Three of eight eyes (37.5%) showed the disappearance of retinoschisis at a mean of 6.8 months (range: 1.7–21 months), but the remaining patients still had retinoschisis at the final visit. Ocular complications were full-thickness macular hole and iatrogenic retinal detachment in each case. The final corrected visual acuity improved to 0.29 logMAR.

Conclusions

Vitrectomy is an effective treatment for patients with optic disc pit maculopathy. It achieved anatomical and visual improvements over a long period of time. However, retinoschisis due to inner retinal fluid remained in many patients.

Keywords: Maculopathy, Optic disc pit, Vitrectomy

Figures and Tables

Figure 1

Composite of the representative images from patient 1. (A) fundus photograph showed a round optic pit (white arrows) and serous retinal detachment (yellow arrowheads) at the initial visit. (B) The baseline optical coherence tomographic (OCT) image showed an excavation of the optic disc (asterisk). (C) Macular OCT image demonstrated schisis-like intraretinal fluid in the outer plexiform layer and serous retinal detachment involving macula. (D–H) Serial OCT images showed a gradual reduction of serous retinal detachment and outer retinoschisis at 1, 3, 8, 18, and 27 months, respectively. However, the retinoschisis still remained at the final visit. Snellen visual acuity improved from 0.02 to 0.2.

Figure 2

Composite of the representative images from patient 2. (A, B) Fundus photograph and optical coherence tomographic (OCT) images showed an optic pit (white arrows), retinoschisis and serous retinal detachment (yellow arrowheads) at the baseline. The patient underwent vitrectomy, internal limiting membrane peeling and 18% SF6 tamponade. (C–G) A gradual absorption of intraretinal and subretinal fluid was seen in longitudinal OCT scan images at 3, 9, 16, 24, and 72 months, respectively. The Snellen visual acuity improved 0.2 to 1.0 after vitrectomy.

Figure 3

Composite of the representative images from patient 5. (A, B) Fundus photograph and optical coherence tomography (OCT) images showed the optic pit (white arrows), retinoschisis and and serous retinal detachment (yellow arrowheads) at the initial visit. The patient underwent vitrectomy and internal limiting membrane peeling. (C) After 2 weeks, OCT showed small reduction of intra and subretinal fluid. (D, E) After 2 years, full-thickness macula hole was detected in OCT (white arrowheads). The patient underwent (F–H) OCT images and they showed successful closure of macular hole 3, 12, and 36 months after vitrectomy, autologous internal limiting membrane transplantation and gas tamponade. But retinoschisis remained through the follow-up period. The Snellen visual acuity improved 0.16 to 0.2 at the final visit.

Table 1

Clinical characteristics of patients

Preop. Vac. = preoperative visucal acuity; Prev. Tx. = previous treatment; Px. = phacoemulsification; Vx. = vitrectomy; ILMP = internal limiting membrane peeling; IRF = intraretinal fluid; SRF = subretinal fluid; RD = retinal detachment; Final Vac. = final visucal acuity; F = female; T = temporal; NA = not available; M = male; SF6 = sulfur hexafluoride; IT = inferotemporal; FTMH = full-thickness macular hole; I = inferior; C3F8 = octafluoropropane.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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