Changes in Outcomes of Macular Optical Coherence Tomography Angiography Following Surgery for Optic Disc Pit Maculopathy.

PURPOSE: we aimed to report on the optical coherence tomography angiography (OCTA) outcomes of eight patients with optic disc pit maculopathy (ODP-M) who were treated with 23-gauge pars plana vitrectomy (PPV). METHODS: We examined sixteen eyes of eight patients-eight eyes with ODP-M and eight healthy fellow eyes. Fundus color photography, fundus autofluorescence, fundus fluorescein angiography, optical coherence tomography (OCT), and OCTA were performed. The vascular density, choriocapillaris blood flow (CCBF), and foveal avascular zone (FAZ) were analyzed using OCTA. Moreover, the correlation between the best-corrected visual acuity (BCVA) and macular OCTA parameters was assessed. RESULTS: Compared with the healthy fellow eyes, the eyes with ODP-M preoperatively were found to have decreased BCVA, superficial capillary plexus (SCP) vascular density (i.e., total, foveal, parafoveal, and perifoveal), deep capillary plexus (DCP) vascular density (i.e., total, parafoveal, and perifoveal), and CCBF but a significantly increased FAZ (p < 0.05). When the eyes with ODP-M were analyzed pre- and postoperatively at month 12 after surgery, the BCVA, SCP vascular density (i.e., perifoveal), and CCBF had significantly increased, and the FAZ had significantly decreased (p < 0.05). When the eyes with ODP-M were compared with the healthy fellow eyes postoperatively at month 12, the BCVA, SCP, and DCP vascular density parameters had increased, along with CCBF, and the FAZ had decreased in eyes with ODP-M, though not to the levels of the healthy fellow eyes (p < 0.05). Moreover, a positive correlation was found between the postoperative BCVA and SCP total vascular density (p < 0.05). CONCLUSION: The BCVA and macular OCTA parameters improved in eyes with ODP-M at month 12 following surgery. However, the BCVA and OCTA of the eyes operated on did not reach the levels of the healthy fellow eyes, possibly due to impaired choroidal blood flow (CBF) recovery and the presence of a larger FAZ. In summary, OCTA seems to be useful for assessing qualitative and quantitative perioperative microvascular changes.

Congenital Optic Disc Anomalies: Insights from Multimodal Imaging.

In this comprehensive review, we delve into the significance of multimodal imaging in diagnosing and managing complications of congenital optic disc anomalies. While the fundus examination is the gold standard tool in the diagnosis of these pathologies, spectral domain (SD) optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) could shed light on the pathogenesis and treatment. Moreover, this review seeks to offer a comprehensive insight into the multimodal approach of these rare congenital pathologies. In conclusion, congenital anomalies of the optic nerve represent a major challenge for ophthalmologists. Further research could be useful to clarify the pathophysiology of these diseases and define a correct and more specific treatment approach.

An unusual coexistence of iris mammillations and optic disc pit with keratoconus: A case report and literature review.

Iris mammillations are distinctive uniform nipple-like elevations that cover the anterior surface of the iris partially or totally. It is a rare finding and may coexist with other ocular and extraocular manifestations. Optic nerve pit (ONP), also known as optic disc pit (ODP) or optic hole, is a congenital defect resulting from the failure of fetal fissure closure during the embryonic development. It belongs to the congenital cavitary anomalies spectrum. This case presents a 19-year-old female patient who complained of a gradual decrease in visual acuity in both eyes for 4 years. Slit-lamp and fundus examinations revealed iris mammillations and ODP in the left eye. Corneal topography revealed bilateral keratoconus, which was managed with cross-linking. Iris mammillations and ODP are poorly understood ocular anomalies that are not reported frequently and have never been reported previously both combined with keratoconus. Thus, ophthalmologists should be aware of these conditions, their differential diagnosis, and their possible association with other disorders. This is the first reported case of the combined coexistence of iris mammillations and ODP with keratoconus.

Successful resolution of serous macular detachment following glaucoma-filtering surgery alone for acquired optic disc pit maculopathy.

PURPOSE: To describe a case of acquired glaucomatous optic disc pit-related maculopathy successfully treated with glaucoma filtering surgery alone. CASE DESCRIPTION: A 67-year-old male was diagnosed with advanced primary open angle glaucoma in both eyes, with a cup: disc ratio of 0.85 in the right eye and 0.95 in the left eye. Visual acuity at presentation was 20/60, and intraocular pressure was 14 mm Hg in the left eye. The fundus of the left eye revealed a serous macular retinal detachment due to an acquired optic disc pit. RESULTS: The left eye of the patient underwent combined cataract and glaucoma filtering surgery. The serous macular detachment resolved completely 15 months after surgery, with a documented visual acuity of 20/40 and intraocular pressure of 10 mm Hg without the use of additional antiglaucoma medications. There was no recurrence of serous macular detachment even after the two-year follow-up visit. CONCLUSION: This case demonstrates that controlling intraocular pressure alone resulted in complete resolution of serous macular detachment in acquired optic disc pit maculopathy without the need for pars plana vitrectomy.

Bimanual Technique With Perfluoro-N-Octane for Human Amniotic Membrane Transplantation in Refractory Optic Disc Pit Maculopathy.

Purpose: To describe a patient with optic disc pit (ODP) maculopathy who presented with poor vision and treatment outcomes. Methods: An amniotic membrane transplantation (AMT) was performed using a bimanual technique with perfluoro-N-octane endotamponade after failure of other techniques to yield resolution of subretinal fluid (SRF). Results: Successful adhesion of the human amniotic membrane graft to the host resulted in sustained resolution of the SRF and significant improvement in visual acuity within 2 weeks. Conclusions: AMT is a viable therapeutic option for patients with vision loss associated with submacular fluid from ODPs. The bimanual technique with perfluorocarbon assistance provides the vitreoretinal surgeon with an additional technical alternative for surgical treatment of ODP maculopathy.

Application progress of human amniotic membrane in vitreoretinopathy: a literature review.

Recently, the application of the amniotic membrane (AM) in ophthalmology is gradually expanding from the anterior to the posterior segment of the eye. Its characteristics of anti-inflammation, anti-bacterial, anti-vascularization, immune regulation, anti-fibrosis, pro-epithelialization, and so forth have made it a hot topic in ophthalmic research. AM has been confirmed to repair photoreceptors, restore normal retinal structures, and close the abnormal structures in the optic disc. Currently, the application areas mainly include retinal hole, retinal detachment, optic disc pit, retinal degenerative diseases, and choroidal hole. This article reviews the current literature applying AM transplantation in the treatment of various posterior segment diseases while comparing the clinical outcomes with other techniques.

Congenital versus acquired optic disc pit maculopathy: An OCT based study.

PURPOSE: The purpose of this study is to describe and compare the demographic, ocular, and imaging characteristics of a cohort of patients with congenital and acquired optic disc pit maculopathy (ODPM). METHODS: This retrospective case series included patients diagnosed with ODPM between June 2017 and April 2023. These patients' baseline demographics, ocular characteristics, and optical coherence tomography (OCT) imaging characteristics and follow up changes were analyzed. RESULTS: A total of 14 eyes with ODPM were identified (9 congenital and 5 acquired). Eyes with congenital ODP developed maculopathy at a younger age, presented commonly with visual symptoms, and exhibited an obvious pit at the temporal foveal margin as well as a high cup: disc ratio (p < 0.05). Primary open-angle glaucoma was identified in all five eyes with acquired ODPM. On OCT, eyes with acquired ODPM lacked the characteristic nerve fibre layer schisis, outer retinal layer hole, and foveal serous macular detachment (p < 0.05) unlike congenital ODPM. At the final follow-up visit, two cases from the congenital ODPM group and one case from the acquired ODPM group displayed complete resolution of maculopathy. The two cases of congenital ODPM were treated with pars plana vitrectomy and laser barrage to the optic disc margin, while the solitary case of acquired ODPM was treated with trabeculectomy surgery alone. CONCLUSION: Clinical examination and baseline OCT imaging reveal distinct differences between congenital and acquired ODPM eyes. These characteristics may help with accurate diagnosis and treatment planning for these two distinct clinical entities.

A unique case of bilateral nanophthalmos and pigmentary retinal abnormality with unilateral angle closure glaucoma and optic disc pit.

BACKGROUND: Microophthalmos or 'dwarf eye' is characterized by an axial length 2 standard deviation less than age-matched controls. It is classified into nanophthalmos, relative anterior microphthalmos, and posterior microphthalmos based on the anterior segment: posterior segment ratio. Nanophthalmos can occur in association with optic disc drusen, foveoschisis, and retinitis pigmentosa, as an autosomal recessive syndrome linked to mutations in the MFRP gene. We report a case of bilateral nanophthalmos and pigmentary retinopathy with angle closure glaucoma and optic disc pit in one eye. We believe this to be the first case presenting with optic disc pit in association with nanophthalmos. CASE PRESENTATION: A 56-year-old female presented with bilateral small eyes, high hypermetropia, shallow anterior chamber depth, increased lens thickness, mid-peripheral retinal flecks, and macular edema. She also had high intraocular pressure in the right eye, with a disc cupping of 0.9 with an Optic disc pit. The macular edema in the right eye was found to occur in association with the Optic disc pit, whereas, in the left eye, it was associated with intra-retinal hemorrhages and diagnosed as macular branch retinal vein occlusion secondary to hypertension. She was started on anti-glaucoma medications in both eyes and planned for Anti-VEGF injection in the left eye. CONCLUSION: This case report is unique as it reports an association of Nanophthalmos with Optic Disc pit, with an associated angle closure glaucoma in the same eye, an association which has never been previously reported in the literature.

Evaluation of baseline optic disc pit and optic disc coloboma maculopathy features by spectral domain optical coherence tomography.

PURPOSE: The aim of this study is to describe and compare the baseline demographic, ocular, and imaging characteristics of a cohort of patients with optic disc pit (ODP) or optic disc coloboma (ODC) maculopathy. METHODS: This retrospective study included patients diagnosed with ODP or ODC on clinical examination between June 2017 and December 2022. These patients' baseline demographics, ocular characteristics, and optical coherence tomography (OCT) imaging characteristics were analyzed. RESULTS: Fundus examination revealed 11 eyes of 11 patients with ODP and 14 eyes of 9 patients with ODC, respectively. On OCT, maculopathy was observed more frequently in ODP (n = 10) than in ODC (n = 4) [p = 0.004] cases. Eyes with ODP were more likely to exhibit retinoschisis and/or serous macular detachment [SMD] (n = 7, 70%), communication of the retinoschisis with the optic disc (p = 0.015), whereas the SMD did not communicate with the optic disc (p = 0.005), and significant outer retinal layer thinning (p = 0.015). In contrast, eyes with ODC exhibited only SMD (p = 0.005) and no retinoschisis on the non-colobomatous retina. SMD in ODC communicated with the margin of the optic disc. In both clinical entities, hyperreflective foci were observed in the SMD. CONCLUSION: In summary, baseline maculopathy characteristics on OCT, including its type, location, and relationship to the optic disc, are among the most distinguishing characteristics between an ODP and an ODC. TRIAL REGISTRATION NUMBER: Not applicable.

Long-term outcomes of autologous platelet treatment for optic disc pit maculopathy.

PURPOSE: Optic disc pits (ODPs) are rare congenital cavitary abnormalities of the optic nerve head, which can lead to serous macular detachments. The aim of this study was to evaluate the long-term efficacy of pars plana vitrectomy (PPV) combined with autologous platelet concentrate (APC) for the treatment of optic disc pit maculopathy (ODP-M). METHODS: A retrospective analysis was performed on eleven eyes of ten patients with ODP-M, who received PPV combined with APC. Nine eyes operated primary, four of which had a repeat surgery also with injection of APC and two eyes underwent a rescue surgery, after they have been operated in another eye center without APC. Morphological and functional results were the main outcome parameters, determined by optical coherence tomography (OCT) and best-corrected visual acuity (BCVA), respectively. RESULTS: The mean duration of visual loss before surgery was 4.7 ± 3.89 months (range 0-12 months). The mean BCVA increased significantly from 0.82 ± 0.33 logMAR (range 0.4-1.3) preoperatively to 0.51 ± 0.36 logMAR (range 0-1.2) at the last examination (p = 0.0022). A significant morphological improvement was also noticed with decrease of the mean foveal thickness from 935.82 ± 248.48 µm (range 559-1400 µm) preoperatively to 226.45 ± 76.09 µm (range 110-344 µm) at the final examination (p < 0.0001). The patients were followed-up for a mean 65.36 ± 48.81 months (range 1-144 months). Two eyes developed postoperatively a retinal detachment. Cataract surgery was performed in 5 eyes during the follow-up period. CONCLUSION: Our study demonstrated that PPV with APC can improve functional and morphological outcomes, both as a primary and a rescue therapy, without any recurrence over a long follow-up period. To the best of our knowledge, this was the longest observation period regarding the use of APC in treatment of ODP-M.

Inverted ILM Flap Technique in Optic Disc Pit Maculopathy.

Purpose: To present the outcome of optic disc pit maculopathy (ODPM) managed successfully with an inverted internal limiting membrane (ILM) flap over the optic disc. A narrative review of ODPM pathogenesis and surgical management techniques are also provided. Case Report: This prospective interventional case series included three eyes of three adult patients (25-39 years old) with unilateral ODPM and a mean duration of unilaterally decreased visual acuity of 7.33 ± 2.40 months (4-12 months). The pars plana vitrectomy with posterior vitreous detachment induction was performed on eyes, followed by an inverted ILM flap insertion over the optic disc and gas tamponade. Patients were followed for 7-16 weeks postoperatively; best-corrected visual acuity (BCVA) improved dramatically in one patient from 2/200 to 20/25. BCVA in other patients improved two and three lines - to 20/50 and 20/30, respectively. A significant anatomical improvement was achieved in all three eyes, and no complication was detected throughout the follow-up period. Conclusion: Vitrectomy with inverted ILM flap insertion over the optic disc is safe and can yield favorable anatomical improvement in patients with ODPM.

The Short-Term Results of Autologous Platelet-Rich Plasma as an Adjuvant to Re-Intervention in the Treatment of Refractory Full-Thickness Macular Holes.

The purpose of this study was to investigate the short-term efficacy and safety of autologous platelet-rich plasma (a-PRP) as an adjuvant to revisional vitrectomy for refractory full-thickness macular holes (rFTMHs). We conducted a prospective, non-randomized interventional study including patients with rFTMH after a pars plana vitrectomy (PPV) with internal limiting membrane peeling and gas tamponade. We included 28 eyes from 27 patients with rFTMHs: 12 rFTMHs in highly myopic eyes (axial length greater than 26.5 mm or a refractive error greater than -6D or both); 12 large rFTMHs (minimum hole width > 400 µm); and 4 rFTMHs secondary to the optic disc pit. All patients underwent 25-G PPV with a-PRP, a median time of 3.5 ± 1.8 months after the primary repair. At the six-month follow-up, the overall rFTMH closure rate was 92.9%, distributed as follows: 11 out of 12 eyes (91.7%) in the highly myopic group, 11 out of 12 eyes (91.7%) in the large rFTMH group, and 4 out of 4 eyes (100%) in the optic disc pit group. Median best-corrected visual acuity significantly improved in all groups, in particular from 1.00 (interquartile range: 0.85 to 1.30) to 0.70 (0.40 to 0.85) LogMAR in the highly myopic group (p = 0.016), from 0.90 (0.70 to 1.49) to 0.40 (0.35 to 0.70) LogMAR in the large rFTMH group (p = 0.005), and from 0.90 (0.75 to 1.00) to 0.50 (0.28 to 0.65) LogMAR in the optic disc pit group. No intraoperative or postoperative complications were reported. In conclusion, a-PRP can be an effective adjuvant to PPV in the management of rFTMHs.

Management of unresolved optic disc pit maculopathy with human amniotic membrane patch implant: A case report.

BACKGROUND/PURPOSE: Inverted Inner Limiting Membrane (ILM)-flap approach can fail in the treatment of Optic disc pit maculopathy (ODPM). We report a surgical technique involving human amniotic membrane (hAM) patch implant to treat unresolved ODPM after inverted (ILM)-flap technique. CASE REPORT: One patient with decreased visual acuity (1 LogMar) after unsuccessful inverted ILM-flap technique to treat ODPM, underwent hAM patch implant and was evaluated. A surgical approach including a 2 mm size graft patch of hAM implantation over the optic disc pit followed by fluid-air exchange was performed. A gas endotamponade was finally used. The patient was instructed to maintain face-down position for the first three days after surgery. The hAM patch remained detectable over the pit for the entire 6-months follow-up. The ODPM gradually resolved and visual acuity partially recovered to 0.17 LogMar during follow-up. No postoperative complications or recurrence were reported. CONCLUSION: hAM patch implant may be effective to manage ODPM after unsuccessful inverted ILM-flap.

Management of recurrent optic disc pit-associated maculopathy with human amniotic membrane graft in a pediatric case.

Background: Optic disc pit-associated maculopathy (ODP-M) is a rare presentation in children. Therefore, only a few pediatric cases successfully managed have been reported in the literature. This video shows successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence with intraoperative optical coherence tomography (OCT). Purpose: To demonstrate a successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence. Synopsis: A 13-year-old patient who had been previously operated with 25-G pars plana vitrectomy with double internal limiting membrane peel and juxtapapillary endolaser with SF 6 gas tamponade for optic disc pit-associated maculopathy (ODP-M) presented with recurrence 9 months after primary surgery. Three 25-G sclerotomies were made and human amniotic membrane graft was tucked into the ODP; the position of the graft was confirmed with intraoperative ocular coherence tomography. Subretinal fluid rapidly resolved within 48 h and best-corrected visual acuity improved to 0.5 logMAR after one week. Later follow-ups showed no complications or recurrence. Highlights: This video shows successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence with intraoperative optical coherence tomography (OCT), without any additional tamponade. Video Link: https://youtu.be/rM79P7oU7GE.

Congenital optic disc pits and optic disc pit maculopathy: a review.

Optic disc pits are a rare but significant anomaly of the optic nerve head that can lead to visual impairment and associated complications. These pits are characterized by a small, oval-shaped depression in the disc, which can cause fluid accumulation and subsequent damage to the adjacent retina. Although the etiology and pathogenesis of optic disc pits are not fully understood, several theories have been proposed, including abnormal embryonic development and degenerative changes. Diagnosis is typically made through a comprehensive eye examination, including a dilated fundus exam and optical coherence tomography. Management options vary depending on the severity of the condition and associated complications, ranging from observation to surgical intervention.

Optic Disc Pit Associated With Choroidal Coloboma: Case Report And Short Review.

Optic disc pits are hypothesized to form because of failure of embryonic fissure closure, which can also present with congenital defects in the choroid, RPE, and neurosensory retina. It is also associated with serous macular detachment. We present a case report of a 32-year-old man with an optic disc pit and independent choroidal coloboma below the inferior peripapillary area in the left eye, associated with macular retinoschisis with serous detachment.

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.

Choroidal neo-vascular membrane in a paediatric optic disc pit: A case report.

Purpose: To report a paediatric patient with unilateral optic nerve pit found to have choroidal neo-vascular membrane in the same eye. Observation: An 8-year old girl known to have a unilateral optic nerve pit presented with exotropia of the right eye. On examination, her vision was 20/40; sub-retinal haemorrhage was noted on clinical fundus exam and a sub retinal vascular net was confirmed on optical coherence tomography angiography. Conclusion and importance: The unusual finding of a choroidal neo-vascular membrane in a known optic nerve pit case represents a new finding of a possible complication. Patients with optic nerve pit may be considered as candidates for OCT-angiography for further diagnosis and proper treatment leading to improved vision, care and prognosis.

Natural Course of Optic Disc Pit Maculopathy: An Optical Coherence Tomography Study.

PURPOSE: The aim of this study was to analyze the impact of OCT characteristics on the natural course of optic disc pit maculopathy (ODP-M). METHODS: This was a single-center, retrospective, observational case series. Patients with ODP-M were included in the study. Baseline demographic characteristics, central macular thickness (CMT), IPP, subretinal fluid (SRF), subretinal precipitations, outer retinal fluid (ORF), and outer retinal layer hole were evaluated. The changes in the OCT characteristics were analyzed with respect to the best-corrected visual acuity (BCVA) from baseline to the last visit. RESULTS: Twenty-two eyes of 22 patients were evaluated with a mean follow-up time of 37.6 (median 22) months. The mean BCVA was 0.31 logMAR at baseline and 0.28 logMAR at the final visit (p = 0.521). Baseline BCVA was significantly related to CMT (ß coefficient 0.001, p = 0.002). Mean BCVA increased in 7 patients (group 1), remained stable in nine (group 2), and decreased (group 3) in 6 patients. No significant difference was found between the groups regarding the baseline BCVA, CMT, and extent of retinal fluid. In patients with subretinal deposits, BCVA remained stable in 3 patients and worsened in one. ORF was recorded in all patients. In patients with SRF, the mean change of BCVA during follow-up differed significantly, depending on the presence (0.07 logMAR) or absence (-0.125 logMAR) of SRF (p = 0.019). CONCLUSION: Among the OCT characteristics, SRF was a negative prognostic factor in ODP-M. Most ODP-M patients showed improved or stable vision over 3 years of follow-up. Therefore, observation may be considered in patients with reasonable vision and without SRF even when they present with remarkable OCT findings.