Conservative surgical management of optic disc pit maculopathy
Reviewed by Annes Ahmeidat

Four cases are presented in this case report that illustrates the option of conservative surgical management for optic disc pit complicated by maculopathy (ODP-M). Four men aged 24-67-years-old with no spontaneous resolution of ODP-M for a minimum of three months, with one participant lasting four years before treatment initiation, were included in this case report. Preoperatively, visual acuity (VA) ranged from 20/70 to 20/100. The authors undertook vitrectomy with induction of posterior vitreous detachment (PVD) and peeling of the internal limiting membrane (ILM) restricted to, what the authors call, the interpapillary macular zone which is speculated to be the area between the optic disc and macula. Postoperatively, VA improvement rate varied between cases, with three of the cases reaching at least 20/25 after a minimum of around eight months. One case reached a maximum improvement of 20/40 postoperatively and was thought to be a result of deterioration over the four years, suggesting duration of OPD-M played a role. Fundal autofluorescence and ocular coherence tomography images for the four participants were provided at varying time frames highlighting anatomical improvement. Amongst the theories of ODP-M pathogenesis, the authors believe vitreous traction around the ODP mediating fluid migration into intra- and subretinal spaces to be the most accredited. There are currently no accepted guidelines on the management of ODP-M. Previous authors utilised various therapeutic options including: laser photocoagulation of temporal disc margin to prevent fluid migration; intravitreal gas injection to reattach the macula, macular buckling surgery; and PVD combined with gas tamponade to reattach macula and prevent the hypothesised vitreous traction. However, laser is a source of visual field defects and gas tamponade will result in cataract as well as increased intraocular pressure exacerbating any abnormal vitreoretinal traction. As the cause of ODP-M remains unknown, it is possible that the technique utilised in this report succeeded due to vitreous traction in the four participants. Nonetheless, the conservative approach in this report yielded VA improvements and was free of complications highlighting its efficacy.

A conservative surgical approach to treatment of optic disc pit maculopathy: four case reports.
Rapizzi E, Gallon P, Ponzin D, et al.
CASE REPORTS IN OPHTHALMOLOGY
2020;11:196-204.