Abstract
Objectives
To evaluate the efficacy of inner retinal fenestration as a surgical technique for the treatment of optic disc pit maculopathy (ODPM) in the paediatric population.
Methods
This is a retrospective, interventional case series of paediatric patients with ODPM treated at two tertiary hospitals in London by a single surgeon (SCW). All patients underwent pars plana vitrectomy with the creation of two inner retinal fenestrations and endogas tamponade. The partial-thickness retinotomies were made radial to the optic disc pit using a 25-gauge MVR blade. Anatomic and visual outcomes were determined by optical coherence tomography central retinal thickness and best-corrected visual acuity (BCVA), respectively.
Results
A total of six eyes were included. Average patient age was 12.0 ± 3.5 years. Preoperatively all eyes demonstrated intraretinal fluid and/or serous detachment of the central macula. Patients were followed for a mean of 22.7 ± 16.1 months after surgery. Mean preoperative BCVA was logMAR 0.71 ± 0.29 (20/100). Mean postoperative BCVA was 0.49 ± 0.30 (20/63) at 2 weeks, 0.35 ± 0.33 (20/45) at 3 months and 0.16 ± 0.29 (20/32) at 1 year. Progressive resolution of intraretinal and subretinal fluid (SRF) was observed in all eyes, with central retinal thickness significantly improved by 2 weeks postoperatively (637.83 ± 209.09 µm preoperatively and 465.40 ± 169.86 µm postoperatively, p = 0.04). Recurrence of subretinal or intraretinal fluid was not observed.
Conclusion
Dual inner retinal fenestration is an effective technique that resolves fluid and restores vision in paediatric patients with ODPM. These results support the hypothesis that enabling egress of fluid into the vitreous cavity can achieve long-lasting amelioration of ODPM.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Christoforidis JB, Terrell W, Davidorf FH. Histopathology of optic nerve pit-associated maculopathy. Clin Ophthalmol. 2012;6:1169–74. https://doi.org/10.2147/OPTH.S34706
Meyer CH, Rodrigues EB, Schmidt JC. Congenital optic nerve head pit associated with reduced retinal nerve fibre thickness at the papillomacular bundle. Br J Ophthalmol. 2003;87:1300–1.
Gass JD. Serous detachment of the macula. secondary to congenital pit of the optic nervehead. Am J Ophthalmol. 1969;67:821–41. 0002-9394(69)90075-0
Brown GC, Shields JA, Patty BE, Goldberg RE. Congenital pits of the optic nerve head. I. Experimental studies in collie dogs. Arch Ophthalmol. 1979;97:1341–4.
Steel DHW, Suleman J, Murphy DC, Song A, Dodds S, Rees J. Optic disc pit maculopathy: a two-year nationwide prospective population-based study. Ophthalmology. 2018;125:1757–64. S0161-6420(18)30774-7
Lincoff H, Lopez R, Kreissig I, Yannuzzi L, Cox M, Burton T. Retinoschisis associated with optic nerve pits. Arch Ophthalmol. 1988;106:61–7.
Lincoff H, Schiff W, Krivoy D, Ritch R. Optic coherence tomography of optic disk pit maculopathy. Am J Ophthalmol. 1996;122:264–6. S0002-9394(14)72021-5
Turkcuoglu P, Taskapan C. The origin of subretinal fluid in optic disc pit maculopathy. Ophthalmic Surg Lasers Imaging Retin. 2016;47:294–8. https://doi.org/10.3928/23258160-20160229-15
Makdoumi K, Nilsson TK, Crafoord S. Levels of beta-trace protein in optic disc pit with macular detachment. Acta Ophthalmol. 2017;95:815–9. https://doi.org/10.1111/aos.13527
Gupta RR, Choudhry N. Spontaneous resolution of optic disc pit maculopathy after posterior vitreous detachment. Can J Ophthalmol. 2016;51:e24–7. https://doi.org/10.1016/j.jcjo.2015.09.020
Apple DJ, Rabb MF, Walsh PM. Congenital anomalies of the optic disc. Surv Ophthalmol. 1982;27:3–41. 0039-6257(82)90111-4
Mustonen E, Varonen T. Congenital pit of the optic nerve head associated with serous detachment of the macula. Acta Ophthalmol (Copenh). 1972;50:689–98.
Cox MS, Witherspoon CD, Morris RE, Flynn HW. Evolving techniques in the treatment of macular detachment caused by optic nerve pits. Ophthalmology. 1988;95:889–96. S0161-6420(88)33078-2
Theodossiadis GP. Treatment of maculopathy associated with optic disk pit by sponge explant. Am J Ophthalmol. 1996;121:630–7. S0002-9394(14)70628-2
Lincoff H, Yannuzzi L, Singerman L, Kreissig I, Fisher Y. Improvement in visual function after displacement of the retinal elevations emanating from optic pits. Arch Ophthalmol. 1993;111:1071–9.
Snead MP, James N, Jacobs PM. Vitrectomy, argon laser, and gas tamponade for serous retinal detachment associated with an optic disc pit: a case report. Br J Ophthalmol. 1991;75:381–2.
Dai S, Polkinghorne P. Peeling the internal limiting membrane in serous macular detachment associated with congenital optic disc pit. Clin Exp Ophthalmol. 2003;31:272–5. 652
Poulson AV, Snead DR, Jacobs PM, Ahmad N, Snead MP. Intraocular surgery for optic nerve disorders. Eye (Lond). 2004;18:1056–65. 6701572
Hirakata A, Okada AA, Hida T. Long-term results of vitrectomy without laser treatment for macular detachment associated with an optic disc pit. Ophthalmology. 2005;112:1430–5. S0161-6420(05)00310-6
Hirakata A, Hida T, Wakabayashi T, Fukuda M. Unusual posterior hyaloid strand in a young child with optic disc pit maculopathy: intraoperative and histopathological findings. Jpn J Ophthalmol. 2005;49:264–6. https://doi.org/10.1007/s10384-004-0185-5
Ishikawa K, Terasaki H, Mori M, Sugita K, Miyake Y. Optical coherence tomography before and after vitrectomy with internal limiting membrane removal in a child with optic disc pit maculopathy. Jpn J Ophthalmol. 2005;49:411–3. https://doi.org/10.1007/s10384-004-0225-1
Schaal KB, Wrede J, Dithmar S. Internal drainage in optic pit maculopathy. Br J Ophthalmol. 2007;91:1093. 91/8/1093 [pii]
Ghosh YK, Banerjee S, Konstantinidis A, Athanasiadis I, Kirkby GR, Tyagi AK. Surgical management of optic disc pit associated maculopathy. Eur J Ophthalmol. 2008;18:142–6.
Georgalas I, Petrou P, Koutsandrea C, Papaconstadinou D, Ladas I, Gotzaridis E. Optic disc pit maculopathy treated with vitrectomy, internal limiting membrane peeling, and gas tamponade: a report of two cases. Eur J Ophthalmol. 2009;19:324–6.
Hirakata A, Inoue M, Hiraoka T, McCuen BW II. Vitrectomy without laser treatment or gas tamponade for macular detachment associated with an optic disc pit. Ophthalmology. 2012;119:810–8. https://doi.org/10.1016/j.ophtha.2011.09.026
Theodossiadis GP, Grigoropoulos VG, Liarakos VS, Rouvas A, Emfietzoglou I, Theodossiadis PG. Restoration of the photoreceptor layer and improvement of visual acuity in successfully treated optic disc pit maculopathy: a long follow-up study by optical coherence tomography. Graefes Arch Clin Exp Ophthalmol. 2012;250:971–9. https://doi.org/10.1007/s00417-011-1918-z
Postel EA, Pulido JS, McNamara JA, Johnson MW. The etiology and treatment of macular detachment associated with optic nerve pits and related anomalies. Trans Am Ophthalmol Soc. 1998;96:73–88. discussion 88-93
Spaide RF, Fisher Y, Ober M, Stoller G. Surgical hypothesis: inner retinal fenestration as a treatment for optic disc pit maculopathy. Retina. 2006;26:89–91. 00006982-200601000-00014
Ooto S, Mittra RA, Ridley ME, Spaide RF. Vitrectomy with inner retinal fenestration for optic disc pit maculopathy. Ophthalmology. 2014;121:1727–33. https://doi.org/10.1016/j.ophtha.2014.04.006
Georgalas I, Ladas I, Georgopoulos G, Petrou P. Optic disc pit: a review. Graefes Arch Clin Exp Ophthalmol. 2011;249:1113–22. https://doi.org/10.1007/s00417-011-1698-5
Benatti E, Garoli E, Viola F. Spontaneous resolution of optic disk pit maculopathy in a child after a six-year follow-up. Retin Cases Brief Rep. 2021;15:453–6. https://doi.org/10.1097/ICB.0000000000000815.
Polunina AA, Todorova MG, Palmowski-Wolfe AM. Function and morphology in macular retinoschisis associated with optic disc pit in a child before and after its spontaneous resolution. Doc Ophthalmol. 2012;124:149–55. https://doi.org/10.1007/s10633-012-9314-5
Akca Bayar S, Sarigul Sezenoz A, Yaman Pinarci E, Yilmaz G. Spontaneous regression of optic disc pit maculopathy in a six-year-old child. Turk J Ophthalmol. 2017;47:56–58. https://doi.org/10.4274/tjo.57614
Bottoni F, Cereda M, Secondi R, Bochicchio S, Staurenghi G. Vitrectomy for optic disc pit maculopathy: a long-term follow-up study. Graefes Arch Clin Exp Ophthalmol. 2018;256:675–82. https://doi.org/10.1007/s00417-018-3925-9
Lincoff H, Kreissig I. Optical coherence tomography of pneumatic displacement of optic disc pit maculopathy. Br J Ophthalmol. 1998;82:367–72.
Author information
Authors and Affiliations
Contributions
SCW was responsible for identifying the patients, performing the procedure, interpreting results and revising the manuscript, figures and tables. NKS was responsible for analysing data, interpreting the results, writing the manuscript and creating the reference list, figures and tables.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Wong, S.C., Scripsema, N.K. Inner retinal fenestration for paediatric optic disc pit maculopathy: a case series. Eye 36, 2111–2115 (2022). https://doi.org/10.1038/s41433-021-01813-6
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41433-021-01813-6
