Surgical Approaches to Optic Disc Pit Maculopathy: A Clinical Case Series.

The purpose of this study was to compare the clinical outcomes of 13 patients with optic disc pit maculopathy (ODP-M) - progressive visual loss, serous macular detachment, and/or intraretinal fluid - who underwent different surgical approaches. This was a retrospective study including a consecutive sample of 13 patients aged 13-74 years (mean 35.38 ± 19.66 years) diagnosed with ODP-M and submitted to vitreoretinal surgery between 2005 and 2021. All patients underwent pars plana vitrectomy, posterior hyaloid detachment, and gas tamponade. Endolaser photocoagulation was applied to the temporal margin of the optic disc in 8 cases; internal limiting membrane (ILM) peeling was performed in 9 cases; and ILM inverted flap technique in 5 cases. Stuffing of the pit with an ILM flap was performed in 3 cases. Mean best-corrected visual acuity improved from 20/200 (1.04 ± 0.56 LogMAR) to 20/50 (0.43 ± 0.54 LogMAR) within 4-36 months. Central retinal thickness decreased from 587.5 ± 158.01 µm to 253.9 ± 33.55 µm, and 7 out of 10 patients had complete resolution of intraretinal fluid. All patients had complete retinal reattachment; however, a few years after surgery, 4 patients had recurrence of serous retinal detachment. The only adjunctive technique associated with greater visual improvement was endolaser (p = 0.033) and not performing peeling of the ILM was also associated with better visual results (p = 0.013), independently of preoperative visual acuity or age at the time of surgery. None of the adjunctive procedures was a significant predictor of better anatomical outcomes. In conclusion, all of these approaches for the surgical management of ODP-M were safe and effective. In this study, vitrectomy with endolaser was a good option for management of ODP-M.

Epiretinal Proliferations Associated with Lamellar Macular Holes: Clinical and Surgical Implications.

OBJECTIVES: To describe the prevalence of lamellar hole-associated epiretinal proliferation (LHEP) and to correlate this finding with lamellar macular hole (LMH) morphology and prognosis after a surgical or conservative approach. METHODS: This is a retrospective multicenter case series comprising consecutive LMH patients followed for ≥6 months. Serial spectral-domain optical coherence tomographies were evaluated for the presence of epiretinal membrane (ERM) and LHEP, diameter of the LMH aperture, base, and floor thickness. Pars plana vitrectomy with ERM and internal limiting membrane peeling was performed in the surgical cases. RESULTS: A total of 62 eyes from 57 consecutive patients were included. Mean follow-up time was 27.1 ± 19.8 months. LHEP was observed in 33 (53.2%) eyes. Patients with LMH and LHEP presented a larger external diameter (p = 0.001) and thinner floors (p = 0.018). Twenty-seven (81.8%) of the patients with LMH and LHEP presented a degenerative intraretinal cavitation, compared to 23.3% in the non-LHEP group (p = 0.001). No differences were observed in visual performance or closure rate between the 2 groups after surgery or in the subset of patients followed conservatively. CONCLUSIONS: LHEP was correlated with the anatomical conformation of the LMH, yielding thinner floors and larger external diameters. However, it did not correlate with the anatomical or functional results, both in the patients who underwent surgery and in those managed conservatively.

A propensity score matching application: indications and results of adding scleral buckle to vitrectomy: The Retina 1 Project: Report 3.

PURPOSE: To identify the indications and differences in outcomes for adding a scleral buckle (SB) to pars plana vitrectomy (PPV) in a prospective series of rhegmatogenous retinal detachment (RD) by using propensity score matching (PSM) to analyze causal effects in observational studies. METHODS: Data were collected from the Retina 1 Project, a prospective, interventional, nonrandomized study of consecutive RDs. Case selection was based upon treatment with PPV or PPV+SB. Surgeons followed personal criteria for the inclusion of SB in the PPV. Propensity score matching corrected for selection biases. Outcomes were assessed by anatomic and visual criteria and the development of proliferative vitreoretinopathy. RESULTS: Of 523 patients analyzed, 251 had PPV and 272 had PPV+SB. Surgeons used PPV+SB more frequently in younger patients with RD, in those with posterior or unidentified breaks, in phakic eyes, in eyes with the posterior vitreous attached, and for more extended RDs. Overall single surgery anatomic success rate was 86.4%. Based on PSM, there were no difference in reattachment rates of the PPV group, 86.9%, and the PPV+SB group, 85.93%. The incidence of PVR was similar in both groups, with 8.5% in the PPV group and 10.5% in the PPV+SB group. CONCLUSIONS: Data from the Retina 1 Project established the indications for adding SB to PPV in treating primary RD in this series. No anatomic or visual differences between PPV and PPV+SB were found.