Cargando…
Optic disc pit maculopathy: tamponade of maculoschisis
PURPOSE: To present rapid and safe closure of the pit-macula communication (PMC) by core vitrectomy and adequate duration gas tamponade as our preferred method of resolving optic disc pit (ODP) maculopathy and to define the term “maculoschisis” in ODP maculopathy as an alternative to the term “schis...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733345/ https://www.ncbi.nlm.nih.gov/pubmed/31564824 http://dx.doi.org/10.2147/OPTH.S212421 |
_version_ | 1783449966144913408 |
---|---|
author | Morris, Robert E Hashimi, Hannah McFarland, Andrew J Kuhn, Ferenc Sapp, Mathew Oltmanns, Matthew |
author_facet | Morris, Robert E Hashimi, Hannah McFarland, Andrew J Kuhn, Ferenc Sapp, Mathew Oltmanns, Matthew |
author_sort | Morris, Robert E |
collection | PubMed |
description | PURPOSE: To present rapid and safe closure of the pit-macula communication (PMC) by core vitrectomy and adequate duration gas tamponade as our preferred method of resolving optic disc pit (ODP) maculopathy and to define the term “maculoschisis” in ODP maculopathy as an alternative to the term “schisis-like.” PATIENT AND METHODS: A twenty-four-year-old female presented with an optical coherence tomography (OCT) confirmed ODP and a “giant” communicating maculoschisis cavity. Central macular thickness (CMT) measured 906 microns, and macular volume was twice normal, at 20.8 mm(3). Snellen corrected visual acuity was 20/70. Two months after initial vitrectomy performed elsewhere with short-term gas tamponade (SF(6) 20%), CMT and visual acuity were not significantly improved. Combined lens extraction/intraocular lens placement and repeat vitrectomy with C(3)F(8) 15% gas tamponade were performed, with one supplemental (office) gas injection. RESULTS: OCT imaging six weeks postoperatively showed definitive closure of the PMC with CMT reduced by 405 microns. Sequestered from its ODP source, foveal schisis fluid then resolved by 12 weeks postoperatively. At final follow-up 3.4 years postoperatively, the macula remained dry with a CMT of 322 microns and a concave foveal contour. Macular volume was reduced to (a normal) 10.2 mm(3) and visual acuity had improved to 20/25. CONCLUSION: No report heretofore has documented rapid, sustained closure of the PMC by gas tamponade as the preferred method of expeditiously resolving ODP maculopathy. However, tamponade PMC closure sequesters ODP fluid and uniquely provides early assurance of ultimate maculopathy resolution. In all other techniques, PMC closure is a trailing phenomenon and success remains uncertain during months to a year or more of (unsequestered) fluid resolution. We suggest that more invasive techniques (laser barrier application to the peripapillary choroid, vitreoretinal interface maneuvers, and pit-plugging) be withheld unless a recurrence is detected during subsequent examinations. |
format | Online Article Text |
id | pubmed-6733345 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-67333452019-09-27 Optic disc pit maculopathy: tamponade of maculoschisis Morris, Robert E Hashimi, Hannah McFarland, Andrew J Kuhn, Ferenc Sapp, Mathew Oltmanns, Matthew Clin Ophthalmol Original Research PURPOSE: To present rapid and safe closure of the pit-macula communication (PMC) by core vitrectomy and adequate duration gas tamponade as our preferred method of resolving optic disc pit (ODP) maculopathy and to define the term “maculoschisis” in ODP maculopathy as an alternative to the term “schisis-like.” PATIENT AND METHODS: A twenty-four-year-old female presented with an optical coherence tomography (OCT) confirmed ODP and a “giant” communicating maculoschisis cavity. Central macular thickness (CMT) measured 906 microns, and macular volume was twice normal, at 20.8 mm(3). Snellen corrected visual acuity was 20/70. Two months after initial vitrectomy performed elsewhere with short-term gas tamponade (SF(6) 20%), CMT and visual acuity were not significantly improved. Combined lens extraction/intraocular lens placement and repeat vitrectomy with C(3)F(8) 15% gas tamponade were performed, with one supplemental (office) gas injection. RESULTS: OCT imaging six weeks postoperatively showed definitive closure of the PMC with CMT reduced by 405 microns. Sequestered from its ODP source, foveal schisis fluid then resolved by 12 weeks postoperatively. At final follow-up 3.4 years postoperatively, the macula remained dry with a CMT of 322 microns and a concave foveal contour. Macular volume was reduced to (a normal) 10.2 mm(3) and visual acuity had improved to 20/25. CONCLUSION: No report heretofore has documented rapid, sustained closure of the PMC by gas tamponade as the preferred method of expeditiously resolving ODP maculopathy. However, tamponade PMC closure sequesters ODP fluid and uniquely provides early assurance of ultimate maculopathy resolution. In all other techniques, PMC closure is a trailing phenomenon and success remains uncertain during months to a year or more of (unsequestered) fluid resolution. We suggest that more invasive techniques (laser barrier application to the peripapillary choroid, vitreoretinal interface maneuvers, and pit-plugging) be withheld unless a recurrence is detected during subsequent examinations. Dove 2019-09-05 /pmc/articles/PMC6733345/ /pubmed/31564824 http://dx.doi.org/10.2147/OPTH.S212421 Text en © 2019 Morris et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Morris, Robert E Hashimi, Hannah McFarland, Andrew J Kuhn, Ferenc Sapp, Mathew Oltmanns, Matthew Optic disc pit maculopathy: tamponade of maculoschisis |
title | Optic disc pit maculopathy: tamponade of maculoschisis |
title_full | Optic disc pit maculopathy: tamponade of maculoschisis |
title_fullStr | Optic disc pit maculopathy: tamponade of maculoschisis |
title_full_unstemmed | Optic disc pit maculopathy: tamponade of maculoschisis |
title_short | Optic disc pit maculopathy: tamponade of maculoschisis |
title_sort | optic disc pit maculopathy: tamponade of maculoschisis |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733345/ https://www.ncbi.nlm.nih.gov/pubmed/31564824 http://dx.doi.org/10.2147/OPTH.S212421 |
work_keys_str_mv | AT morrisroberte opticdiscpitmaculopathytamponadeofmaculoschisis AT hashimihannah opticdiscpitmaculopathytamponadeofmaculoschisis AT mcfarlandandrewj opticdiscpitmaculopathytamponadeofmaculoschisis AT kuhnferenc opticdiscpitmaculopathytamponadeofmaculoschisis AT sappmathew opticdiscpitmaculopathytamponadeofmaculoschisis AT oltmannsmatthew opticdiscpitmaculopathytamponadeofmaculoschisis |