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


METHODS
Noncomparative, retrospective, interventional case series.


METHODS
Eight consecutive patients (8 to 56 years of age) with unilateral macular detachment associated with optic disc pit.


METHODS
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.


METHODS
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.
Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan. hirakata@eye-center.org
Akito
A
Hirakata
Makoto
M
Inoue
Tomoyuki
T
Hiraoka
Brooks W
BW
McCuen
D000328:Adult; D002648:Child; D058450:Endotamponade; D005124:Eye Abnormalities / Q000150:complications*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000002:abnormalities*; D012163:Retinal Detachment / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000379:methods*; D020255:Vitreous Detachment / Q000601:surgery*; D055815:Young Adult