Vitrectomy without laser treatment or gas tamponade for macular detachment associated with an optic disc pit.

PURPOSE: To evaluate the clinical outcomes after vitrectomy, without gas tamponade or laser photocoagulation to the margin of the optic nerve, for the treatment of macular detachment associated with optic disc pits and to characterize retinal manifestations during treatment of optic pit maculopathy using optical coherence tomography (OCT). DESIGN: Noncomparative, retrospective, interventional case series. PARTICIPANTS: Eight consecutive patients (8 to 56 years of age) with unilateral macular detachment associated with optic disc pit. INTERVENTION: Pars plana vitrectomy with induction of a posterior vitreous detachment (PVD) was performed in all eyes. No laser or gas injection was performed in any eye during the original surgery. Patients were followed up for 10 to 46 months (mean, 26 months) after surgery. MAIN OUTCOME MEASURES: Anatomic outcome as determined by OCT and postoperative visual acuities were the main outcome parameters. Fundus autofluorescence (FAF) images were obtained in 4 eyes to document anatomic changes in the macula. RESULTS: Although complete retinal reattachment was achieved in 7 of 8 eyes, up to about 1 year was necessary for the retinal detachment to resolve fully. The 1 eye in which macular detachment failed to resolve completely underwent revision of vitrectomy with a gas tamponade and laser photocoagulation in the peripapillary area. In the early postoperative period, despite persistent macular detachment, the visual acuities improved in 7 eyes. These improved acuities corresponded with remodeling of the photoreceptor outer segments on OCT and the appearance of granular hyperfluorescence on FAF imaging. CONCLUSIONS: Vitrectomy with induction of a PVD at the optic disc without gas tamponade or laser photocoagulation seems to be an effective method of managing macular detachment resulting from optic disc pits. The OCT scanning before and after surgery suggests that peripapillary vitreous traction with the passage of fluid into the retina through the pit is the cause of the schisis-like separation seen in optic disc pit maculopathy.

Duke Scholars

Author Brooks W. McCuen II Ophthalmology, Vitreoretinal Diseases & Surgery