First Author: J.Märtz GERMANY
Co Author(s): S. Priglinger G. Rudolph A. Wolf
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Comparison of fate and behavior of different surgical tamponade agents in patients with optic disc pit (ODP) related maculopathy (ODP-M) undergoing vitrectomy. Investigation of the structural changes after intraocular tamponade of ODPs and ODP-M using spectral domain optical coherence tomography (SD-OCT) and spectral domain enhanced depth optical coherence tomography (SD-EDI-OCT).
In this observational study four female patients (16 to 26 years) with ODP-M, underwent vitrectomy with a mean time of postoperative follow-up of 18 months. 4 eyes with 5 ODPs and ODP-M were examined. Surgical approach with and without parapapillar subthreshold laser-treatment, and different means of intraocular tamponade were analyzed.
Data examined included clinical history, ophthalmological examination, fundus photography and optical coherence tomography. ODP-M was defined as alteration of the papillomaculary and macular retina in patients with ODPs including detachment of retinal layers, retinoschisis and macular hole formation with severely reduced vision. Retinal alterations were visualized by OCT. Especially optic nerve head (ONH) area, peripapillary and macular area were repeatedly examined with SD-OCT and SD-EDI-OCT over up to 32 months. The detectability and behavior of the different agents of intraocular tamponades of the ODP (C2F6, internal limiting membrane (ILM) flap, autologous thrombocyte concentrate, combinations of these) were analyzed.
All patients showed an improvement in visual acuity (VA) after surgery. Mean initial VA was ~0.08 dec. resembling 1.13 logMAR ± standard deviation of the sample (SD) of 0.34. Postoperative mean VA ranged at ~0.2 dec. resembling 0.70 logMAR ± SD 0.44. Air tamponade was detectable about 1 week, whereas gas tamponade (C2F6) was detectable about 4 weeks. ILM-flaps remained rather unaltered over time (up to 30 month), but showed no sufficient obstruction of the ODP on OCT-imaging. Autologous thrombocyte concentrate was still visible within the vitreous cavity after 10 days. Tamponade with autologous thrombocytes underwent a significant remodelling process when it was dropped into the ODP-cavity, similar to the intrapapillary proliferations observed inside ODPs in untreated eyes. The thrombocyte concentrate or the resultant remodeled tissue were detectable for 5 month so far and lead to obstruction of the ODP-cavity. One eye receiving macular hole surgery, 15% C2F6 tamponade and autologous thrombocyte concentrate improved from 0.70 logMAR (0.2 dec.) to 0.2 logMAR (0.63 dec.). Follow up showed that it can take more than 30 months until sub- and intraretinal fluid is finally resolved.
Starting with rather low VA preoperatively, all examined eyes with ODP-M showed improvement of VA after surgery in this study. Tamponade of the ODP with autologous thrombocytes can lead to obstruction of the ODP and to subsequent remodelling of the intrapapillary tissue that was not found in other tamponade agents. This may aid resolving residual sub- and intraretinal fluid in the postoperative course, but further studies are needed to verify these effects.