Session Title: FP-16 Vitreoretinal Surgery IV
Session Date/Time: Sunday 14/09/2014 | 11:00-13:00
Paper Time: 11:24
Venue: Boulevard D
First Author: : P.E.Stanga UK
Co Author(s): : M. Gil-Martinez S. Pastor-Idoate K. Yau S. Biswas C. Lloyd
Optic Disc Pit (ODP) maculopathy is a rare disease, characterised by the association of a colobomatous excavation of the optic nerve head with macular subretinal fluid and/or schisis. Its pathogenesis is still controversial and different surgical approaches have been reported only on case series.
Manchester Royal Eye Hospital, Manchester Vision Regeneration (MVR) Lab at NIHR/ Wellcome Trust Manchester CRF, Academic Health Science Centre and Centre for Ophthalmology and Vision Research, Institute of Human Development, University of Manchester, UK
Interventional case report. A five-year-old girl who presented with ODP and serous macular detachment underwent Swept-Source optical coherence tomography (SS-OCT) (DRI-OCT1 Atlantis®, Topcon Corp, Japan) followed by pars plana vitrectomy (PPV) with air tamponade. Detachment of the posterior hyaloid (PVD) was induced during PPV, intra-optic nerve head excavation fibrosis was removed with forceps and fluid/air exchange was carried out to induce air tamponade.
Pre-operatively, SS-OCT showed 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. SS-OCT also showed the presence of serous detachment and schisis of the macula. At 11 months postoperatively, the serous macular detachment was resolved and the optic pit reduced in size.
SS-OCT showed anatomical features not previously described in ODP maculopathy and this allowed a new surgical approach. In patients with documented vitreous attachment on the optic nerve head and peri-pit fibrosis; PVD induction, fibrosis excision and tamponade with air alone may be a viable alternative to tamponade with gas with or without laser photocoagulation in the treatment of ODP maculopathy. This new and less invasive surgical approach does not require posturing in children and may be associated with a lower risk of development of cataract or amblyopia