Vitrectomy with inner retinal fenestration for optic disc pit maculopathy

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OBJECTIVE: To evaluate the clinical outcomes after vitrectomy with inner retinal fenestration-making a partial thickness retinal hole radial to the pit-for the treatment of optic disc pit maculopathy. DESIGN: Retrospective, interventional case series. PARTICIPANTS: Eighteen eyes with optic disc pit maculopathy. INTERVENTION: Pars plana vitrectomy with creation of an inner retinal fenestration was performed in all eyes. A bent 25-gauge needle was used to make a partial thickness inner retinotomy just temporal to the optic disc pit. MAIN OUTCOME MEASURES: Anatomic outcomes determined by optical coherence tomography and postoperative best-corrected visual acuity (BCVA). RESULTS: Before surgery, gross thickening of the inner and outer retinal layers with accumulation of fluid in the central macula was present in all eyes. Macular detachment was observed in 14 eyes, and outer layer hole was identified in 9 eyes. Patients were followed up for a mean of 34.6+/-26.6 months after surgery. After surgery, complete resolution of fluid in and under the fovea was achieved in 17 eyes (94%) without additional treatment. In these eyes, reduction of the inner retinal fluid was followed by a slow decrease in the outer retinal fluid and macular detachment. The macular detachment resolved in a mean of 6.1+/-3.9 months after surgery. Postoperative BCVA (mean, 0.378+/-0.487 logarithm of the minimum angle of resolution [logMAR]; Snellen equivalent, 20/48) improved significantly compared with preoperative BCVA (mean, 0.725+/-0.510 logMAR; Snellen equivalent, 20/106; P = 0.006). Ten eyes (56%) had a postoperative BCVA of 20/30 or better. There was neither the recurrence of macular detachment nor an accumulation of outer retinal fluid in the central macula in any eyes. CONCLUSIONS: The introduction of a partial thickness fenestration radial to the optic disc pit was associated with retinal anatomic and functional improvement without additional treatments. These results are consistent with the hypothesis that redirection of flow to allow egress of fluid into the vitreous cavity instead of into the retina can achieve long-lasting amelioration of the pathologic findings of optic pit maculopathy.

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