Inverted ILM flap technique in Optic Disc Pit Maculopathy: An Iranian experience with review of the literature

Abstract Purpose To present the outcome of optic disc pit maculopathy (ODPM) managed successfully with inverted internal limiting membrane (ILM) flap over the optic disc. Methods This prospective case series included three patients with ODPM who underwent pars plana vitrectomy with posterior vitreous detachment induction, followed by inverted ILM flap over the optic disc and gas tamponade. Patients were followed for 7-16 weeks as regards their functional and anatomical findings. A narrative review is also provided about Pathology, Pathogenesis, and surgical techniques in the treatment of ODPM Results Three adult patients (25–39 years old) were evaluated, with a mean duration of decreased visual acuity of 7.33 ± 2.40 months (4-12 months). Postoperatively, BCVA improved dramatically in one patient from 2/200 to 20/25. BCVA in the other two improved two and three lines, to 20/50 and 20/30, respectively. Significant anatomic improvement was achieved in all patients. Conclusion Vitrectomy with inverted ILM flap insertion over the optic disc can yield favorable anatomical improvement in patients with ODPM.

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Resolution of Optic Disc Pit Maculopathy Following Posterior Vitreous Detachment

Journal of VitreoRetinal Diseases ◽

10.1177/24741264211046766 ◽

2021 ◽

pp. 247412642110467

Author(s):

Ali H. Mannaa ◽

Reda A. Issa ◽

J. Shepard Bryan

Keyword(s):

Optic Disc ◽

Posterior Vitreous Detachment ◽

Interesting Case ◽

Optic Disc Pit ◽

Review Of The Literature ◽

Fluid Accumulation ◽

Optic Pit ◽

Vitreous Detachment ◽

Spontaneous Improvement ◽

Optic Disc Pit Maculopathy

Purpose: This work presents a case of significant improvement of optic pit disc maculopathy following an acute posterior vitreous detachment (PVD) and discusses the possible mechanisms of this phenomenon. Methods: A case report and review of the literature are presented. Results: A 56-year-old man presenting with progressive visual decline in his left eye was found to have an optic disc pit with optical coherence tomography (OCT) evidence of severe intraretinal edema and maculoschisis. His visual acuity and macular anatomy on OCT improved dramatically in the months following a PVD. Conclusions: This report presents an interesting case of spontaneous improvement of optic disc pit–related maculopathy following PVD. We discuss the cause of the retinal fluid accumulation in optic disc pit maculopathy and consider that the OCT findings in our case lend credence to the theory that this fluid originates from the vitreous humor.

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A Conservative Surgical Approach to the Treatment of Optic Disc Pit Maculopathy: Four Case Reports

Case Reports in Ophthalmology ◽

10.1159/000507880 ◽

2020 ◽

Vol 11 (2) ◽

pp. 196-204

Author(s):

Emilio Rapizzi ◽

Paola Gallon ◽

Diego Ponzin ◽

Stefano Ferrari ◽

Nicola Zemella

Keyword(s):

Optic Disc ◽

Case Reports ◽

Posterior Vitreous Detachment ◽

Subretinal Fluid ◽

Internal Limiting Membrane ◽

Conservative Approach ◽

Optic Disc Pit ◽

Surgical Interventions ◽

Optic Disc Pit Maculopathy ◽

Intravitreal Gas

The purpose of this report is to present the outcomes of surgical interventions in 4 patients with maculopathy associated with optic disc pit (ODP). We report 4 cases of patients affected by ODP maculopathy and treated by core vitrectomy with induction of posterior vitreous detachment and peeling of the internal limiting membrane restricted to the interpapillary macular zone without laser treatment and gas tamponade. The patients had rapid resolution of the multilayer inner retinoschisis-like separation and progressive slow reabsorption of the macular intraretinal and subretinal fluid up to complete retinal reattachment. Currently, there are still no widely accepted guidelines related to the best technique in the management of the maculopathy associated with ODP. We used a conservative approach, without the adoption of intravitreal gas injection or laser.

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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’

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-315075 ◽

2020 ◽

pp. bjophthalmol-2019-315075 ◽

Cited By ~ 2

Author(s):

Naresh Babu ◽

Piyush Kohli ◽

Kim Ramasamy

Keyword(s):

Optic Disc ◽

Surgical Techniques ◽

Subretinal Fluid ◽

Internal Limiting Membrane ◽

Optic Disc Pit ◽

Ilm Peeling ◽

Post Surgery ◽

Optic Disc Pit Maculopathy ◽

Group 2 ◽

Anatomical Success

AimTo compare the anatomical and visual outcomes of vitrectomy with internal limiting membrane (ILM) peeling alone versus inverted ILM flap to plug the pit versus autologous scleral plug for the treatment of optic disc pit maculopathy (ODP-M).MethodsThis retrospective study included 23 patients (23 eyes) who underwent 25G pars plana vitrectomy, ILM peeling and gas tamponade. While the pit was not plugged in group 1 (n=8), inverted ILM flap and autologous scleral flap were used to plug the pit in group 2 (n=7) and group 3 (n=8), respectively. Complete anatomical success was defined as total resolution of subretinal fluid (SRF) and macular schisis on optical coherence tomography while visual success was defined as a gain of at least 2 Snellen lines 1 year after surgery.ResultsBaseline characteristics were similar in all three groups. Mean central foveal thickness and SRF decreased in all three groups (p<0.05). Complete anatomical success was achieved in 25.0%, 85.7% and 87.5% eyes while visual success was achieved in 12.5%, 28.6% and 12.5% eyes in groups 1, 2 and 3, respectively. One eye (4.3%) in group 2 developed full-thickness macular hole at 1 month post-surgery. After complete resolution, there was no recurrence of fluid.ConclusionOPD-M has a better surgical outcome if the pit is plugged. Both inverted ILM flap and autologous scleral plug are equally efficacious adjuncts to plug the pit.

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Long-term outcomes of pars plana vitrectomy without internal limiting membrane peeling for optic disc pit maculopathy

Eye ◽

10.1038/eye.2013.172 ◽

2013 ◽

Vol 27 (12) ◽

pp. 1359-1367 ◽

Cited By ~ 26

Author(s):

R Avci ◽

S Yilmaz ◽

U U Inan ◽

B Kaderli ◽

M Kurt ◽

...

Keyword(s):

Optic Disc ◽

Pars Plana Vitrectomy ◽

Internal Limiting Membrane ◽

Optic Disc Pit ◽

Long Term Outcomes ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling ◽

Pars Plana ◽

Optic Disc Pit Maculopathy

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Optic Disc Pit Maculopathy: One-Year Outcomes of Pars Plana Vitrectomy with Foveal Sparing Inverted Internal Limiting Membrane Flap

Cureus ◽

10.7759/cureus.14057 ◽

2021 ◽

Author(s):

Palmeera D'souza ◽

Shishir Verghese ◽

Ratnesh Ranjan ◽

Karan Kumarswamy ◽

Veerappan R Saravanan ◽

...

Keyword(s):

Optic Disc ◽

Pars Plana Vitrectomy ◽

Internal Limiting Membrane ◽

Optic Disc Pit ◽

Pars Plana ◽

Optic Disc Pit Maculopathy ◽

One Year ◽

Foveal Sparing

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Management of optic disc pit-associated maculopathy: A case series from a tertiary referral center

European Journal of Ophthalmology ◽

10.1177/11206721211023727 ◽

2021 ◽

pp. 112067212110237

Author(s):

Ilkay Kilic Muftuoglu ◽

Ecem Onder Tokuc ◽

V Levent Karabas

Keyword(s):

Optic Disc ◽

Case Series ◽

Internal Limiting Membrane ◽

Maximum Height ◽

Optic Disc Pit ◽

Tertiary Referral Center ◽

Number Of Patients ◽

The Mean ◽

Foveal Center

Purpose: To report outcomes of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) stuffing technique in patients with optic disc pit associated maculopathy (ODP-M). Methods: Data including best-corrected visual acuity (BCVA), central macular thickness (CMT), foveal center point thickness (FCP), and maximum height of fluid (max_fluid) (intraretinal or subretinal) were collected from the medical records of the patients. Results: Six eyes of six patients with a mean age of 28.0 ± 17.68 years (range: 9–53 year) underwent PPV + ILM plug surgery. The mean follow-up duration was 25.62 ± 26.11 months (range: 11.80–78.00 month) duration. The mean BCVA increased from 1.25 ± 1.04 logMAR (20/355, Snellen equivalent) to 0.86 ± 1.09 logMAR (20/144, Snellen equivalent) at last follow-up ( p = 0.043). Compared to baseline, CMT, FCP, and max_fluid significantly decreased at all visits after the surgery ( p < 0.05 for all visits). At last follow-up, 66.6% of the eyes (four eyes) showed complete resolution of fluid at a mean of 5.25 ± 4.99 months (range: 1–12 months) after the surgery. Conclusion: PPV with ILM plug seemed to be an effective surgical technique in ODP-M. Studies with longer follow-up and higher number of patients are needed to confirm our results.

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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

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2015-307128 ◽

2015 ◽

Vol 100 (4) ◽

pp. 478-483 ◽

Cited By ~ 24

Author(s):

Marwan A Abouammoh ◽

Sulaiman M Alsulaiman ◽

Vishali S Gupta ◽

Ahmed Mousa ◽

Akito Hirakata ◽

...

Keyword(s):

Optic Disc ◽

Pars Plana Vitrectomy ◽

Laser Photocoagulation ◽

Study Group ◽

Optic Disc Pit ◽

Pars Plana ◽

Optic Disc Pit Maculopathy ◽

International Collaborative

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Macular Structure Recovery after Surgery for Optic Disc Pit Maculopathy

Case Reports in Ophthalmology ◽

10.1159/000504619 ◽

2019 ◽

Vol 10 (3) ◽

pp. 408-414

Author(s):

Yuri Nishiyama ◽

Yuji Yoshikawa ◽

Masayuki Shibuya ◽

Junji Kanno ◽

Kimitake Ozaki ◽

...

Keyword(s):

Optic Disc ◽

Outer Layer ◽

Sulfur Hexafluoride ◽

Structural Changes ◽

Present Report ◽

Serous Retinal Detachment ◽

Posterior Vitreous Detachment ◽

Recovery Process ◽

Optic Disc Pit ◽

Optic Disc Pit Maculopathy

The present report aimed to describe the macular structure’s recovery process in a case of optic disc pit maculopathy (ODP-M) with outer layer hole following pars plana vitrectomy (PPV) with juxtapapillary laser treatment (JPL). We performed repeated optical coherence tomography (OCT) examinations to evaluate the macular structural changes. An 80-year-old man presented with distorted vision and decreased visual acuity (VA) in his left eye, experienced for 1 year, prior to presentation. Fundus examination and OCT showed intraretinal fluid (IRF) in the inner and outer retinal layers. Serous retinal detachment (SRD) with an outer layer hole in the macula was also evident. The IRF was connected to the optic disc; however, the SRD was isolated. Best-corrected VA was 20/100. PPV combined with JPL was performed. Posterior vitreous detachment creation and tamponade with sulfur hexafluoride was performed. Postoperatively, the inner retinal IRF at the fovea disappeared. The outer layer hole gradually closed and had completely disappeared 1 month postoperatively. After resolution of the outer layer hole, SRD reduced gradually and disappeared 8 months postoperatively, although the macular outer retinal IRF remained. The outer retinal IRF had partially resolved by the 18th postoperative month. Macular structure was completely recovered 31 months postoperatively, with an improved VA of 20/20. In conclusion, SRD might be associated with outer retinal IRF and outer layer holes. In cases of ODP-M, outer layer holes might induce optic disc-isolated SRD.

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