Jornal de Oftalmologia Clínica e Experimental
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Pars Plana Vitrectomy with Air Tamponade for Optic Disc Pit Maculopathy: Swept-source Optical Coherence Tomography Imaging Findings and Surgical Approach: A Clinical Case

Pastor-Idoate S, Gil-Martinez M, Yau K, Biswas S, Lloyd IC and Stanga PE

Purpose: To describe how Swept Source Optical Coherence Tomography (SS-OCT) provides enhanced diagnostic information enabling optimisation of surgical strategy in a pediatric patient suffering from ODP maculopathy. We report the first case of successful management of ODP maculopathy via pars plana vitrectomy (PPV) and air tamponade.
Methods: Interventional case report.
Results: A five-year-old girl presented with ODP and serous macular detachment in her previously amblyopic left eye. SS-OCT showed optically opaque vitreous fibres perpendicularly attached to the base of the optic nerve head excavation and what appeared to be fibrous tissue at the base of the excavation of the optic nerve head and attached to the pit. Detachment of the posterior hyaloid was induced during PPV, the pre-optic nerve head fibrosis was removed with forceps and fluid/air exchange was carried out to induce air tamponade. The serous macular detachment had resolved 11 months after the surgery and the optic pit was reduced in size. No maculopathy recurrences or complications such as cataract were observed. Best corrected visual acuity did not improve possibly because of pre-existing amblyopia. Conclusion: SS-OCT demonstrated anatomical features not previously described in ODP maculopathy and could assist in the choice of surgical technique. In patients with ODP maculopathy and documented optic nerve head vitreous attachment with peri-pit fibrosis, vitrectomy supplemented by tamponade with air alone may be a viable alternative to tamponade with gas with or without laser photocoagulation. This modified technique may reduce the risk of complications such as cataract formation.