Clinical observation of pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for optic disc pit maculopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Ni Wei¹ ¹ , Li Xiaoxin ^2,3 , Zeng Siyan ¹ ,  Li Haiping ¹

1. Department of Ophthalmology, Peking University Third Hospital, Beijing 100091, China;
2. Xiamen Eye Center, Affiliated to Xiamen University, Xiamen 361003, China;
3. Eye Center, Peking University People's Hospital, Beijing 100044, China;

Corresponding author：

Li Haiping, Email: drlihaiping@163.com

Keywords：

Optic disc pit; Optic disc pit maculopathy; Subretinal fluid; Pars plana vitrectomy

DOI：

10.3760/cma.j.cn511434-20241209-00473

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Objective To evaluate the clinical efficacy of pars plana vitrectomy (PPV) with internal limiting membrane peeling and gas tamponade in the management of optic disc pit maculopathy (ODP-M). Methods A retrospective case analysis. From 2002 to 2021, 16 patients (16 eyes) diagnosed with ODP-M at Department of Ophthalmology of Peking University Third Hospital and Eye Center of Peking University People's Hospital were included in the study. All affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure, color fundus photography and optical coherence tomography (OCT) examinations. BCVA detection was conducted using a standard logarithmic visual acuity chart, and during statistics, it was converted to the logarithmic minimum angle of resolution (logMAR) visual acuity. According to the treatment methods, the affected eyes were divided into the laser treatment group and the surgical treatment group, with 2 and 14 eyes respectively. The affected eyes in the laser treatment group were only given simple laser photocoagulation treatment. All the affected eyes in the surgical treatment group underwent PPV combined with internal limiting membrane stripping and vitreous cavity filling with 16% SF₆. Among them, autologous platelet concentrate (APC) were simultaneously filled in 5 eyes. The follow-up period after the operation was 13.5 (3-138) months. The differences in the absorption of subretinal fluid (SRF) and the improvement of BCVA in the macular area between the two groups of affected eyes were compared and observed. The absorption of SRF in the macular area measured by OCT was used as the criterion for judging the effectiveness of treatment. The Mann-Whitney U test was used for comparison between the two groups. Results In the surgical treatment group, SRF in the macular area was completely absorbed in 14 eyes, and the complete absorption time was 7.0 (2-23) months. In the laser treatment group, SRF was not absorbed in both eyes. The logMAR BCVA of the surgical treatment group before and after the operation was 0.7 (0.3-2.0) and 0.4 (0.1-1.3), and the difference was statistically significant (Z=2.809, P=0.005). The logMAR BCVA before and after the operation of the eyes with combined APC filling and those without combined APC filling were 0.6 (0.3-1.0) and 0.5 (0.1-0.7), as well as 0.7 (0.3-2.0) and 0.4 (0.2-1.3), respectively. There was no statistically significant difference in logMAR BCVA between the two after surgery (Z=0.609, P=0.543). Conclusions PPV combined with internal limiting membrane peeling and inert gas filling can effectively promote the absorption of SRF in the macular area of eyes with ODP-M, achieve anatomical reduction, and improve BCVA. Combined APC filling fails to provide further improvements in visual outcomes.

1.	Esmaeil A, Ali A, Almutairi S, et al. Congenital optic disc pits and optic disc pit maculopathy: a review[J/OL]. Front Ophthalmol (Lausanne), 2023, 3: 1222979[2023-08-16]. https://pubmed.ncbi.nlm.nih.gov/38983028/. DOI: 10.3389/fopht.2023.1222979.
2.	Shukla D, Kalliath J, Dhawan A. Current advances in the management of optic disc pit maculopathy[J]. Expert Rev Ophthalmol, 2023, 18(4): 249-259. DOI: 10.1080/17469899.2023.2232118.
3.	Steel DHW, Suleman J, Murphy DC, et al. Optic disc pit maculopathy: a two-year nationwide, prospective population-based study[J]. Ophthalmology, 2018, 125(11): 1757-1764. DOI: 10.1016/j.ophtha.2018.05.026.
4.	Babu N, Kohli P, Ramasamy K. Comparison of various surgical techniques for optic disc pit maculopathy: vitrectomy with internal limiting membrane (ILM) peeling alone versus inverted ILM flap 'plug' versus autologous scleral 'plug'[J]. Br J Ophthalmol, 2020, 104(11): 1567-1573. DOI: 10.1136/bjophthalmol-2019-315075.
5.	Meng L, Zhao X, Zhang W, et al. The characteristics of optic disc pit maculopathy and the efficacy of vitrectomy: a systematic review and meta‐analysis[J/OL]. Acta Ophthalmol, 2021, 99(7): e1176-e1189[2021-01-09]. https://pubmed.ncbi.nlm.nih.gov/33421324/. DOI: 10.1111/aos.14816.
6.	Theodossiadis GP, Panopoulos M, Kollia AK, et al. Long-term study of patients with congenital pit of the optic nerve and persistent macular detachment[J]. Acta Ophthalmol, 1992, 70(4): 495-505. DOI: 10.1111/j.1755-3768.1992.tb02130.x.
7.	Uzel MM, Karacorlu M. Optic disk pits and optic disk pit maculopathy: a review[J]. Surv Ophthalmol, 2019, 64(5): 595-607. DOI: 10.1016/j.survophthal.2019.02.006.
8.	Iros M, Parolini B, Ozdek S, et al. Management of optic disc pit maculopathy: the European VitreoRetinal society optic pit study[J/OL]. Acta Ophthalmol, 2022, 100(6): e1264-e1271[2021-12-07]. https://pubmed.ncbi.nlm.nih.gov/34877796/. DOI: 10.1111/aos.15076.
9.	Moisseiev E, Moisseiev J, Loewenstein A. Optic disc pit maculopathy: when and how to treat? A review of the pathogenesis and treatment options[J/OL]. Int J Retina Vitreous, 2015, 1: 13[2015-08-07]. https://pubmed.ncbi.nlm.nih.gov/27847606/. DOI: 10.1186/s40942-015-0013-8.
10.	Christoforidis JB, Terrell W, Davidorf FH. Histopathology of optic nerve pit-associated maculopathy[J]. Clin Ophthalmol, 2012, 6: 1169-1174. DOI: 10.2147/OPTH.S33559.
11.	Jain N, Johnson MW. Pathogenesis and treatment of maculopathy associated with cavitary optic disc anomalies[J]. Am J Ophthalmol, 2014, 158(3): 423-435. DOI: 10.1016/j.ajo.2014.05.020.
12.	Abouammoh MA, Alsulaiman SM, Gupta VS, et al. Pars plana vitrectomy with juxtapapillary laser photocoagulation versus vitrectomy without juxtapapillary laser photocoagulation for the treatment of optic disc pit maculopathy: the results of the KKESH International Collaborative Retina Study Group[J]. Br J Ophthalmol, 2016, 100(4): 478-483. DOI: 10.1136/bjophthalmol-2015-307762.
13.	Pastor-Idoate S, Fusté CGA, García-Onrubia L, et al. Surgical options for optic disc pit maculopathy: perspectives and controversies[J]. Clin Ophthalmol, 2020, 14: 1601-1608. DOI: 10.2147/OPTH.S244553.
14.	Ohno-Matsui K, Hirakata A, Inoue M, et al. Evaluation of congenital optic disc pits and optic disc colobomas by swept-source optical coherence tomography[J]. Invest Ophthalmol Vis Sci, 2013, 54(12): 7769-7778. DOI: 10.1167/iovs.13-13155.
15.	Skaat A, Moroz I, Moisseiev J. Macular detachment associated with an optic pit: optical coherence tomography patterns and surgical outcomes[J]. Eur J Ophthalmol, 2013, 23(3): 385-393. DOI: 10.5301/ejo.5000237.
16.	Khatri A, Shrestha SM, Prasai G, et al. Minimally invasive procedure for optic disc pit maculopathy: vitrectomy with scleral plug and analysis on pattern of resolution[J/OL]. Sci Rep, 2023, 13(1): 15724[2023-09-21]. https://pubmed.ncbi.nlm.nih.gov/37735231/. DOI: 10.1038/s41598-023-42722-w.
17.	Pinheiro RL, Henriques F, Figueira J, et al. Surgical approaches to optic disc pit maculopathy: a clinical case series[J]. Case Rep Ophthalmol, 2022, 13(3): 876-882. DOI: 10.1159/000526888.
18.	Shukla D, Kalliath J, Tandon M, et al. Vitrectomy for optic disk pit with macular schisis and outer retinal dehiscence[J]. Retina, 2012, 32(7): 1337-1342. DOI: 10.1097/IAE.0b013e318236e8ec.
19.	Wang Y, Xu Z, Zhao X, et al. Therapeutic effect of using autologous platelet concentrate in vitrectomy for macular hole: a systematic review and meta-analysis[J]. Retina, 2023, 43(11): 1833-1841. DOI: 10.1097/IAE.0000000000003886.
20.	Rosenthal G, Bartz-Schmidt KU, Walter P, et al. Autologous platelet treatment for optic disc pit associated with persistent macular detachment[J]. Graefe's Arch Clin Exp Ophthalmol, 1998, 236(2): 151-153. DOI: 10.1007/s004170050051.
21.	Todorich B, Sharma S, Vajzovic L. Successful repair of recurrent optic disk pit maculopathy with autologous platelet rich plasma: report of a surgical technique[J]. Retin Cases Brief Rep, 2017, 11(1): 15-17. DOI: 10.1097/ICB.0000000000000284.
22.	Nadal J, Figueroa MS, Carreras E, et al. Autologous platelet concentrate in surgery for macular detachment associated with congenital optic disc pit[J]. Clin Ophthalmol, 2015, 9: 1965-1971. DOI: 10.2147/OPTH.S89911.

1. Esmaeil A, Ali A, Almutairi S, et al. Congenital optic disc pits and optic disc pit maculopathy: a review[J/OL]. Front Ophthalmol (Lausanne), 2023, 3: 1222979[2023-08-16]. https://pubmed.ncbi.nlm.nih.gov/38983028/. DOI: 10.3389/fopht.2023.1222979.
2. Shukla D, Kalliath J, Dhawan A. Current advances in the management of optic disc pit maculopathy[J]. Expert Rev Ophthalmol, 2023, 18(4): 249-259. DOI: 10.1080/17469899.2023.2232118.
3. Steel DHW, Suleman J, Murphy DC, et al. Optic disc pit maculopathy: a two-year nationwide, prospective population-based study[J]. Ophthalmology, 2018, 125(11): 1757-1764. DOI: 10.1016/j.ophtha.2018.05.026.
4. Babu N, Kohli P, Ramasamy K. Comparison of various surgical techniques for optic disc pit maculopathy: vitrectomy with internal limiting membrane (ILM) peeling alone versus inverted ILM flap 'plug' versus autologous scleral 'plug'[J]. Br J Ophthalmol, 2020, 104(11): 1567-1573. DOI: 10.1136/bjophthalmol-2019-315075.
5. Meng L, Zhao X, Zhang W, et al. The characteristics of optic disc pit maculopathy and the efficacy of vitrectomy: a systematic review and meta‐analysis[J/OL]. Acta Ophthalmol, 2021, 99(7): e1176-e1189[2021-01-09]. https://pubmed.ncbi.nlm.nih.gov/33421324/. DOI: 10.1111/aos.14816.
6. Theodossiadis GP, Panopoulos M, Kollia AK, et al. Long-term study of patients with congenital pit of the optic nerve and persistent macular detachment[J]. Acta Ophthalmol, 1992, 70(4): 495-505. DOI: 10.1111/j.1755-3768.1992.tb02130.x.
7. Uzel MM, Karacorlu M. Optic disk pits and optic disk pit maculopathy: a review[J]. Surv Ophthalmol, 2019, 64(5): 595-607. DOI: 10.1016/j.survophthal.2019.02.006.
8. Iros M, Parolini B, Ozdek S, et al. Management of optic disc pit maculopathy: the European VitreoRetinal society optic pit study[J/OL]. Acta Ophthalmol, 2022, 100(6): e1264-e1271[2021-12-07]. https://pubmed.ncbi.nlm.nih.gov/34877796/. DOI: 10.1111/aos.15076.
9. Moisseiev E, Moisseiev J, Loewenstein A. Optic disc pit maculopathy: when and how to treat? A review of the pathogenesis and treatment options[J/OL]. Int J Retina Vitreous, 2015, 1: 13[2015-08-07]. https://pubmed.ncbi.nlm.nih.gov/27847606/. DOI: 10.1186/s40942-015-0013-8.
10. Christoforidis JB, Terrell W, Davidorf FH. Histopathology of optic nerve pit-associated maculopathy[J]. Clin Ophthalmol, 2012, 6: 1169-1174. DOI: 10.2147/OPTH.S33559.
11. Jain N, Johnson MW. Pathogenesis and treatment of maculopathy associated with cavitary optic disc anomalies[J]. Am J Ophthalmol, 2014, 158(3): 423-435. DOI: 10.1016/j.ajo.2014.05.020.
12. Abouammoh MA, Alsulaiman SM, Gupta VS, et al. Pars plana vitrectomy with juxtapapillary laser photocoagulation versus vitrectomy without juxtapapillary laser photocoagulation for the treatment of optic disc pit maculopathy: the results of the KKESH International Collaborative Retina Study Group[J]. Br J Ophthalmol, 2016, 100(4): 478-483. DOI: 10.1136/bjophthalmol-2015-307762.
13. Pastor-Idoate S, Fusté CGA, García-Onrubia L, et al. Surgical options for optic disc pit maculopathy: perspectives and controversies[J]. Clin Ophthalmol, 2020, 14: 1601-1608. DOI: 10.2147/OPTH.S244553.
14. Ohno-Matsui K, Hirakata A, Inoue M, et al. Evaluation of congenital optic disc pits and optic disc colobomas by swept-source optical coherence tomography[J]. Invest Ophthalmol Vis Sci, 2013, 54(12): 7769-7778. DOI: 10.1167/iovs.13-13155.
15. Skaat A, Moroz I, Moisseiev J. Macular detachment associated with an optic pit: optical coherence tomography patterns and surgical outcomes[J]. Eur J Ophthalmol, 2013, 23(3): 385-393. DOI: 10.5301/ejo.5000237.
16. Khatri A, Shrestha SM, Prasai G, et al. Minimally invasive procedure for optic disc pit maculopathy: vitrectomy with scleral plug and analysis on pattern of resolution[J/OL]. Sci Rep, 2023, 13(1): 15724[2023-09-21]. https://pubmed.ncbi.nlm.nih.gov/37735231/. DOI: 10.1038/s41598-023-42722-w.
17. Pinheiro RL, Henriques F, Figueira J, et al. Surgical approaches to optic disc pit maculopathy: a clinical case series[J]. Case Rep Ophthalmol, 2022, 13(3): 876-882. DOI: 10.1159/000526888.
18. Shukla D, Kalliath J, Tandon M, et al. Vitrectomy for optic disk pit with macular schisis and outer retinal dehiscence[J]. Retina, 2012, 32(7): 1337-1342. DOI: 10.1097/IAE.0b013e318236e8ec.
19. Wang Y, Xu Z, Zhao X, et al. Therapeutic effect of using autologous platelet concentrate in vitrectomy for macular hole: a systematic review and meta-analysis[J]. Retina, 2023, 43(11): 1833-1841. DOI: 10.1097/IAE.0000000000003886.
20. Rosenthal G, Bartz-Schmidt KU, Walter P, et al. Autologous platelet treatment for optic disc pit associated with persistent macular detachment[J]. Graefe's Arch Clin Exp Ophthalmol, 1998, 236(2): 151-153. DOI: 10.1007/s004170050051.
21. Todorich B, Sharma S, Vajzovic L. Successful repair of recurrent optic disk pit maculopathy with autologous platelet rich plasma: report of a surgical technique[J]. Retin Cases Brief Rep, 2017, 11(1): 15-17. DOI: 10.1097/ICB.0000000000000284.
22. Nadal J, Figueroa MS, Carreras E, et al. Autologous platelet concentrate in surgery for macular detachment associated with congenital optic disc pit[J]. Clin Ophthalmol, 2015, 9: 1965-1971. DOI: 10.2147/OPTH.S89911.

Chinese Journal of Ocular Fundus Diseases

Latest ArticlesClinical observation of pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for optic disc pit maculopathy

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