Optic disc pit maculopathy: tamponade of maculoschisis
Received 16 April 2019
Accepted for publication 26 July 2019
Published 5 September 2019 Volume 2019:13 Pages 1735—1741
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Robert E Morris,1–3 Hannah Hashimi,4 Andrew J McFarland,1,2,5 Ferenc Kuhn,2,6–7 Mathew Sapp,1–3 Matthew Oltmanns1–3
1Retina Specialists of Alabama, Birmingham, AL, USA; 2Helen Keller Foundation for Research and Education, Birmingham, AL, USA; 3Department of Ophthalmology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA; 4School of Medicine, UAB, Birmingham, AL, USA; 5Retina Associates, Winchester, VA, USA; 6Milos Eye Hospital, Belgrade, Serbia; 7Zagorskeigo Eye Hospital, Krakow, Poland
Correspondence: Robert E Morris
Retina Specialists of Alabama, 2208 University Blvd, Birmingham, AL 35233, USA
Tel +1 205 558 2598
Fax +1 205 558 2596
Purpose: To present rapid and safe closure of the pit-macula communication (PMC) by core vitrectomy and adequate duration gas tamponade as our preferred method of resolving optic disc pit (ODP) maculopathy and to define the term “maculoschisis” in ODP maculopathy as an alternative to the term “schisis-like.”
Patient and methods: A twenty-four-year-old female presented with an optical coherence tomography (OCT) confirmed ODP and a “giant” communicating maculoschisis cavity. Central macular thickness (CMT) measured 906 microns, and macular volume was twice normal, at 20.8 mm3. Snellen corrected visual acuity was 20/70. Two months after initial vitrectomy performed elsewhere with short-term gas tamponade (SF6 20%), CMT and visual acuity were not significantly improved. Combined lens extraction/intraocular lens placement and repeat vitrectomy with C3F8 15% gas tamponade were performed, with one supplemental (office) gas injection.
Results: OCT imaging six weeks postoperatively showed definitive closure of the PMC with CMT reduced by 405 microns. Sequestered from its ODP source, foveal schisis fluid then resolved by 12 weeks postoperatively. At final follow-up 3.4 years postoperatively, the macula remained dry with a CMT of 322 microns and a concave foveal contour. Macular volume was reduced to (a normal) 10.2 mm3 and visual acuity had improved to 20/25.
Conclusion: No report heretofore has documented rapid, sustained closure of the PMC by gas tamponade as the preferred method of expeditiously resolving ODP maculopathy. However, tamponade PMC closure sequesters ODP fluid and uniquely provides early assurance of ultimate maculopathy resolution. In all other techniques, PMC closure is a trailing phenomenon and success remains uncertain during months to a year or more of (unsequestered) fluid resolution. We suggest that more invasive techniques (laser barrier application to the peripapillary choroid, vitreoretinal interface maneuvers, and pit-plugging) be withheld unless a recurrence is detected during subsequent examinations.
Keywords: optic disc pit, ODP, schisis, maculoschisis, ODP maculopathy, vitrectomy, tamponade, optical coherence tomography, OCT
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