Evaluation of the efficacy of a customized surgical approach for congenital optic disc pit with maculopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhu Haiyan , Guo Ju , Zhou Pengyi , Zhai Qianqian , Jin Bo , Xie Kunpeng , Du Liping ,  Jin Xuemin

The First Affiliated Hospital of Zhengzhou University, Henan Eye Hospital, Zhengzhou University Academy of Medical Sciences, Zhengzhou 450003, China;

Corresponding author：

Jin Xuemin, Email: jinxuemin@zzu.edu.cn

Keywords：

Sweep source optical coherence tomography; Congenital optic disc pit; Maculopathy; Submacular fluid accumulation; Pars plana vitrectomy; Personalized surgery

DOI：

10.3760/cma.j.cn511434-20240722-00276

Video：

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Objective To observe the curative effect of a personalized surgical scheme based on scanning source optical coherence tomography (SS-OCT) image features in the treatment of congenital optic disc pit (ODP) with maculopathy (ODP-M). Methods A prospective interventional cohort study. From September 2019 to May 2024, 15 patients with 15 eyes who were diagnosed with ODP-M by ophthalmology examination in Department of Ophthalmonogy of The First Affiliated Hospital of Zhengzhou University were included in the study. Best corrected visual acuity (BCVA) and SS-OCT were performed in all affected eyes. Standard E word visual acuity chart was used for BCVA examination, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for record. The center retinal thickness (CRT) was measured by SS-OCT examination of macular area using VG200D of Henan Technology Co., LTD. According to the morphological characteristics of ODP and the splitting, edema and detachment of macular region, combined with the degree of pulling of the boundary membrane between the posterior vitreous cortex and macular region, a personalized surgical method was designed. Class I: pars plana vitrectomy combined with macular boundary film stripping, ODP boundary film packing and vitreous cavity gas filling. Class Ⅱ: pars plana vitrectomy combined with non-retained macular boundary film stripping or ODP inner boundary film packing, vitreous cavity gas filling. Class Ⅰ and Class Ⅱ operations were performed in 10 and 5 eyes of 15 eyes, respectively. The postoperative follow-up time was ＞6 months. Follow-up time was performed with the same equipment before surgery. BCVA changes, CRT reduction rate and complications were observed. BCVA and CRT were compared before and after operation by paired sample t test. Results There were 15 eyes in 15 cases, 4 eyes in 4 males and 11 eyes in 11 females. The age was (28.87±16.5) years. logMAR BCVA of the affected eye was 0.94±0.51. CRT was (697.80 ± 301.80) μm. At the last follow-up, the logMAR BCVA was 0.53±0.49. CRT was (392.53 ±167.55) μm. Compared with before operation, BCVA and CRT were significantly improved, and the difference was statistically significant (t=3.23, 3.25; P=0.006, 0.006). After surgery, transient intraocular hypertension occurred in 2 eyes, and the intraocular pressure returned to normal level after 3 to 7 days without special treatment. Two eyes underwent an unexpected second operation. Among them, one eye underwent Class Ⅰ surgery, the tunnel at ODP was closed after surgery, and there was a small amount of subretinal fluid in the macular area. Class Ⅱ surgery was performed in 1 eye with retinal reattachment. Conclusion Personalized surgical treatment of ODP-M based on SS-OCT image features can reduce CRT and improve visual acuity.

1.	Steel D, Suleman J, Murphy DC, et al. Optic disc pit maculopathy: a two-year nationwide prospective population-based study[J]. Ophthalmology, 2018, 125(11): 1757-1764. DOI: 10.1016/j.ophtha.2018.05.009.
2.	Shukla D, Kalliath J, Tandon M, et al. Vitrectomy for optic disk pit with macular schisis and outer retinal dehiscence[J]. Retina, 2012, 32(7): 1337-1342. DOI: 10.1097/IAE.0b013e318235d8fc.
3.	Wachtlin J, Schumann RG, Maier M, et al. Macular changes in optic disc pits-optic disc pit maculopathy (ODP-M): pathophysiology and possibilities of surgical treatment[J]. Ophthalmologe, 2019, 116(11): 1026-1032. DOI: 10.1007/s00347-019-0933-z.
4.	Talli PM, Fantaguzzi PM, Bendo E, et al. Vitrectomy without laser treatment for macular serous detachment associated with optic disc pit: long-term outcomes[J]. Eur J Ophthalmol, 2016, 26(2): 182-187. DOI: 10.5301/ejo.5000680.
5.	Pastor-Idoate S, Gómez-Resa M, Karam S, et al. Efficacy of internal limiting membrane flap techniques with vitrectomy for macular detachment associated with an optic disc pit[J]. Ophthalmologica, 2019, 242(1): 38-48. DOI: 10.1159/000495621.
6.	Theodossiadis GP, Theodossiadis PG. The macular buckling technique in the treatment of optic disk pit maculopathy[J]. Semin Ophthalmol, 2000, 15(2): 108-115. DOI: 10.3109/08820530009040001.
7.	Theodossiadis GP, Chatziralli IP, Theodossiadis PG. Macular buckling in optic disc pit maculopathy in association with the origin of macular elevation: 13-year mean postoperative results[J]. Eur J Ophthalmol, 2015, 25(3): 241-248. DOI: 10.5301/ejo.5000553.
8.	Mirza GD, Mirza E, Satirtav G, et al. The outcomes of intravitreal C₃F₈ gas tamponade combined with laser photocoagulation treatment for optic disc pit maculopathy[J]. Int Ophthalmol, 2022, 42(6): 1819-1825. DOI: 10.1007/s10792-021-02179-0.
9.	黄莉, 吕璨璨, 李军, 等. 激光光凝及其联合玻璃体切割手术治疗先天性视盘小凹合并浆液性黄斑脱离: 光相干断层扫描可见“堤坝样”改变是关键[J]. 中华眼底病杂志, 2019, 35(6): 580-583. DOI: 10.3760/cma.j.issn.1005-1015.2019.06.012.Huang L, Lyu CC, Li J, et al. Laser photocoagulation or endolaser combined with vitrectomy for congenital optic disc pit maculopathy: "dam sign" of optical coherence tomography is a sign to indicate the anatomic success[J]. Chin J Ocul Fundus Dis, 2019, 35(6): 580-583. DOI: 10.3760/cma.j.issn.1005-1015.2019.06.012.
10.	Imamura Y, Zweifel SA, Fujiwara T, et al. High-resolution optical coherence tomography findings in optic pit maculopathy[J]. Retina, 2010, 30(7): 1104-1112. DOI: 10.1097/IAE.0b013e3181d87ecb.
11.	Kranenburg EW. Crater-like holes in the optic disc and central serous retinopathy[J]. Arch Ophthalmol, 1960, 64: 912-924. DOI: 10.1001/archopht.1960.01840010914013.
12.	Ohno-Matsui K, Hirakata A, Inoue M, et al. Evaluation of congenital optic disc pits and optic disc colobomas by swept-source optical coherence tomography[J]. Invest Ophthalmol Vis Sci, 2013, 54(12): 7769-7778. DOI: 10.1167/iovs.13-12901.
13.	Brown GC, Shields JA, Patty BE, et al. Congenital pits of the optic nerve head. I. experimental studies in collie dogs[J]. Arch Ophthalmol, 1979, 97(7): 1341-1344. DOI: 10.1001/archopht.1979.01020020083020.
14.	Johnson TM, Johnson MW. Pathogenic implications of subretinal gas migration through pits and atypical colobomas of the optic nerve[J]. Arch Ophthalmol, 2004, 122(12): 1793-1800. DOI: 10.1001/archopht.122.12.1793.
15.	Chatziralli I, Theodossiadis P, Theodossiadis GP. Optic disk pit maculopathy: current management strategies[J]. Clin Ophthalmol, 2018, 12: 1417-1422. DOI: 10.2147/OPTH.S153711.
16.	罗莎莎, 武志峰. 视乳头小凹内界膜填塞术一例[J]. 中华眼视光学与视觉科学杂志, 2019, 21(6): 470-473. DOI: 10.3760/cma.j.issn.1674-845X.2019.06.012.Luo SS, Wu ZF. A case of internal limiting membrane packing in optic disc pit[J]. Chin J Optom Ophthalmol Vis Sci, 2019, 21(6): 470-473. DOI: 10.3760/cma.j.issn.1674-845X.2019.06.012.
17.	Theodossiadis PG, Grigoropoulos VG, Emfietzoglou J, et al. Vitreous findings in optic disc pit maculopathy based on optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2007, 245(9): 1311-1318. DOI: 10.1007/s00417-007-0534-4.
18.	李霞, 彭晓燕. 先天性视盘凹陷性疾病的相干光断层扫描研究进展[J]. 国际眼科纵览, 2020, 44(1): 18-24. DOI: 10.3760/cma.j.issn.1673-5803.2020.01.004.Li X, Peng XY. Congenital optic disc depression: insights from optical coherent tomograph[J]. Int Rev Ophthalmol, 2020, 44(1): 18-24. DOI: 10.3760/cma.j.issn.1673-5803.2020.01.004.
19.	Doyle E, Trivedi D, Good P, et al. High-resolution optical coherence tomography demonstration of membranes spanning optic disc pits and colobomas[J]. Br J Ophthalmol, 2009, 93(3): 360-365. DOI: 10.1136/bjo.2008.141556.
20.	Michalewski J, Michalewska Z, Nawrocki J. Spectral domain optical coherence tomography morphology in optic disc pit associated maculopathy[J]. Indian J Ophthalmol, 2014, 62(7): 777-781. DOI: 10.4103/0301-4738.138184.
21.	Jain N, Johnson MW. Pathogenesis and treatment of maculopathy associated with cavitary optic disc anomalies[J]. Am J Ophthalmol, 2014, 158(3): 423-435. DOI: 10.1016/j.ajo.2014.06.001.

1. Steel D, Suleman J, Murphy DC, et al. Optic disc pit maculopathy: a two-year nationwide prospective population-based study[J]. Ophthalmology, 2018, 125(11): 1757-1764. DOI: 10.1016/j.ophtha.2018.05.009.
2. Shukla D, Kalliath J, Tandon M, et al. Vitrectomy for optic disk pit with macular schisis and outer retinal dehiscence[J]. Retina, 2012, 32(7): 1337-1342. DOI: 10.1097/IAE.0b013e318235d8fc.
3. Wachtlin J, Schumann RG, Maier M, et al. Macular changes in optic disc pits-optic disc pit maculopathy (ODP-M): pathophysiology and possibilities of surgical treatment[J]. Ophthalmologe, 2019, 116(11): 1026-1032. DOI: 10.1007/s00347-019-0933-z.
4. Talli PM, Fantaguzzi PM, Bendo E, et al. Vitrectomy without laser treatment for macular serous detachment associated with optic disc pit: long-term outcomes[J]. Eur J Ophthalmol, 2016, 26(2): 182-187. DOI: 10.5301/ejo.5000680.
5. Pastor-Idoate S, Gómez-Resa M, Karam S, et al. Efficacy of internal limiting membrane flap techniques with vitrectomy for macular detachment associated with an optic disc pit[J]. Ophthalmologica, 2019, 242(1): 38-48. DOI: 10.1159/000495621.
6. Theodossiadis GP, Theodossiadis PG. The macular buckling technique in the treatment of optic disk pit maculopathy[J]. Semin Ophthalmol, 2000, 15(2): 108-115. DOI: 10.3109/08820530009040001.
7. Theodossiadis GP, Chatziralli IP, Theodossiadis PG. Macular buckling in optic disc pit maculopathy in association with the origin of macular elevation: 13-year mean postoperative results[J]. Eur J Ophthalmol, 2015, 25(3): 241-248. DOI: 10.5301/ejo.5000553.
8. Mirza GD, Mirza E, Satirtav G, et al. The outcomes of intravitreal C₃F₈ gas tamponade combined with laser photocoagulation treatment for optic disc pit maculopathy[J]. Int Ophthalmol, 2022, 42(6): 1819-1825. DOI: 10.1007/s10792-021-02179-0.
9. 黄莉, 吕璨璨, 李军, 等. 激光光凝及其联合玻璃体切割手术治疗先天性视盘小凹合并浆液性黄斑脱离: 光相干断层扫描可见“堤坝样”改变是关键[J]. 中华眼底病杂志, 2019, 35(6): 580-583. DOI: 10.3760/cma.j.issn.1005-1015.2019.06.012.Huang L, Lyu CC, Li J, et al. Laser photocoagulation or endolaser combined with vitrectomy for congenital optic disc pit maculopathy: "dam sign" of optical coherence tomography is a sign to indicate the anatomic success[J]. Chin J Ocul Fundus Dis, 2019, 35(6): 580-583. DOI: 10.3760/cma.j.issn.1005-1015.2019.06.012.
10. Imamura Y, Zweifel SA, Fujiwara T, et al. High-resolution optical coherence tomography findings in optic pit maculopathy[J]. Retina, 2010, 30(7): 1104-1112. DOI: 10.1097/IAE.0b013e3181d87ecb.
11. Kranenburg EW. Crater-like holes in the optic disc and central serous retinopathy[J]. Arch Ophthalmol, 1960, 64: 912-924. DOI: 10.1001/archopht.1960.01840010914013.
12. Ohno-Matsui K, Hirakata A, Inoue M, et al. Evaluation of congenital optic disc pits and optic disc colobomas by swept-source optical coherence tomography[J]. Invest Ophthalmol Vis Sci, 2013, 54(12): 7769-7778. DOI: 10.1167/iovs.13-12901.
13. Brown GC, Shields JA, Patty BE, et al. Congenital pits of the optic nerve head. I. experimental studies in collie dogs[J]. Arch Ophthalmol, 1979, 97(7): 1341-1344. DOI: 10.1001/archopht.1979.01020020083020.
14. Johnson TM, Johnson MW. Pathogenic implications of subretinal gas migration through pits and atypical colobomas of the optic nerve[J]. Arch Ophthalmol, 2004, 122(12): 1793-1800. DOI: 10.1001/archopht.122.12.1793.
15. Chatziralli I, Theodossiadis P, Theodossiadis GP. Optic disk pit maculopathy: current management strategies[J]. Clin Ophthalmol, 2018, 12: 1417-1422. DOI: 10.2147/OPTH.S153711.
16. 罗莎莎, 武志峰. 视乳头小凹内界膜填塞术一例[J]. 中华眼视光学与视觉科学杂志, 2019, 21(6): 470-473. DOI: 10.3760/cma.j.issn.1674-845X.2019.06.012.Luo SS, Wu ZF. A case of internal limiting membrane packing in optic disc pit[J]. Chin J Optom Ophthalmol Vis Sci, 2019, 21(6): 470-473. DOI: 10.3760/cma.j.issn.1674-845X.2019.06.012.
17. Theodossiadis PG, Grigoropoulos VG, Emfietzoglou J, et al. Vitreous findings in optic disc pit maculopathy based on optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2007, 245(9): 1311-1318. DOI: 10.1007/s00417-007-0534-4.
18. 李霞, 彭晓燕. 先天性视盘凹陷性疾病的相干光断层扫描研究进展[J]. 国际眼科纵览, 2020, 44(1): 18-24. DOI: 10.3760/cma.j.issn.1673-5803.2020.01.004.Li X, Peng XY. Congenital optic disc depression: insights from optical coherent tomograph[J]. Int Rev Ophthalmol, 2020, 44(1): 18-24. DOI: 10.3760/cma.j.issn.1673-5803.2020.01.004.
19. Doyle E, Trivedi D, Good P, et al. High-resolution optical coherence tomography demonstration of membranes spanning optic disc pits and colobomas[J]. Br J Ophthalmol, 2009, 93(3): 360-365. DOI: 10.1136/bjo.2008.141556.
20. Michalewski J, Michalewska Z, Nawrocki J. Spectral domain optical coherence tomography morphology in optic disc pit associated maculopathy[J]. Indian J Ophthalmol, 2014, 62(7): 777-781. DOI: 10.4103/0301-4738.138184.
21. Jain N, Johnson MW. Pathogenesis and treatment of maculopathy associated with cavitary optic disc anomalies[J]. Am J Ophthalmol, 2014, 158(3): 423-435. DOI: 10.1016/j.ajo.2014.06.001.

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