To evaluate the efficacy of pars plana vitrectomy for congenital optic disk pit maculopathy with various adjuvant techniques, including gas tamponade, internal limiting membrane peel, and temporal optic disk endolaser in a multicenter study with long-term follow-up.
A retrospective chart review was performed to identify eyes that underwent surgical repair for congenital optic disk pits and serous macular detachment with or without macular retinoschisis from four retinal centers across Canada from 2003 to 2013. Data collected included surgeries performed, preoperative and postoperative vision, central retinal thickness, and presence or absence of subretinal fluid. Optical coherence tomography was used to define anatomical success (i.e., foveal reattachment).
Thirty-two eyes of 32 patients with optic disk pits and serous macular detachments were identified that had undergone surgical repair. All eyes underwent pars plana vitrectomy and induction of posterior vitreous detachment if one was not present. Additional procedures performed on occasion included internal limiting membrane peel (n = 8), temporal optic disk pits endolaser (n = 7), and gas tamponade (air, C3F8 or SF6; n = 31). After vitrectomy surgery, foveal attachment was achieved in 26 of 32 eyes (81.3%). The average number of surgeries required was 1.4 ± 0.6, with a maximum of 3 vitrectomies (n = 2). Mean change in best-corrected visual acuity was −0.47 ± 0.54 logMAR units, which corresponds to approximately 5 lines of visual improvement (P < 0.001). Median time to reattachment was 416 days. Preoperative vision, preoperative symptom days, and age were not associated with postoperative reattachment. Similarly, internal limiting membrane peel and temporal endolaser were not associated with postoperative reattachment, nor was there a difference between air and SF6 and C3F8 gas tamponade. Elevated preoperative central retinal thickness was associated with a lower chance of postoperative reattachment (P = 0.007) and was also the best prognostic indicator of success (P = 0.039).
Vitrectomy for macular detachment due to optic disk pit has good long-term success and results in an improvement in visual acuity. However, adjuvant techniques such as internal limiting membrane peel and temporal endolaser may not improve outcomes, nor does there seem to be a difference between short- and long-acting gases. Patients should be made aware that it can take more than a year and multiple surgeries to achieve foveal reattachment and that increased baseline central retinal thickness is a poor prognostic sign.
A retrospective interventional case series of 32 eyes with congenital optic disk pits underwent vitrectomy with various adjuvant techniques including internal limiting membrane peel and gas tamponade. Anatomical closure was achieved in 81.3% of eyes with significant improvement in visual acuity. Elevated preoperative central macular thickness was associated with failure of reattachment. Internal limiting membrane peel and papillomacular endolaser did not play a role in success, and no difference was found between short- and long-acting gas tamponade.
*Department of Ophthalmology, University of Alberta, Royal Alexandra Hospital, Edmonton, Alberta, Canada;
†Department of Ophthalmology, University of Calgary, Calgary, Alberta, Canada; and
‡Department of Ophthalmology, Western University, London, Ontario, Canada.
Reprint requests: Matthew T. S. Tennant, BA, MD, FRCSC, ABO, Department of Ophthalmology, University of Alberta, Suite 400, 10924 107 Avenue, Edmonton, Alberta T5H 0X5, Canada; e-mail: firstname.lastname@example.org
None of the authors have any financial/conflicting interests to disclose.