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Br J Ophthalmol. 2007 August; 91(8): 1093.
PMCID: PMC1954811

Internal drainage in optic pit maculopathy

Optic disc pit with associated serous macular detachment has a poor visual prognosis if left to its natural course. It has been suspected that the subretinal fluid originates from the vitreous cavity via an inner retinoschisis‐like separation within the papillomacular bundle between the optic disc pit and the central retinal detachment.1 We report a surgical approach on the basis of this assumed pathomechanism.

Case report

A 20‐year‐old man presented with decreased vision in OD (right eye) due to macular detachment in association with an optic nerve pit (fig 11).). Visual acuity was 20/400 OD and 20/20 OS (left eye). Optical coherence tomography revealed parapapillar retinoschisis‐like separation of the outer retinal layers and extended full‐thickness neurosensory retinal detachment. There was a round full‐thickness macular hole covered by the posterior hyaloid. The posterior hyaloid was partially detached nasally. After giving informed consent, the patient underwent surgery in May 2004. Limited preretinal vitrectomy and retinal incision in the area of the schisis‐like separation was performed to create a link between the outer schisis‐like separation and the vitreous cavity and thus to interrupt the continuous flow into the subretinal space (fig 11).). The incision was made parallel to the papillomacular bundle, approximately 3/4 deep into the retina using a bent 27‐gauge cannula. No active suction of subretinal fluid or gas tamponade was performed. Postoperatively, the schisis‐like separation was flattened and resolved completely, the macular hole was closed and the retina was reattached (fig 22).). Visual acuity was 20/100 after 1 month, 20/40 after3 months and 20/20 after 9 months. During a follow‐up of 29 months, vision remained stable and no recurrence of the maculopathy occurred.

figure bj110304.f1
Figure 1 Optic pit maculopathy. (A) Preoperative fundus photograph OD. (B) Horizontal optical coherence tomography image demonstrating the presumed fluid flow after surgery (arrows).
figure bj110304.f2
Figure 2 Horizontal optical coherence tomography (OCT) images OD. (A) Preoperative OCT scan. (B) OCT scan 9 months after operation showing flattening of the schisis‐like separation and closure of the macular hole. (C) OCT scan ...

Comment

Various treatment modalities for optic pits with associated macular involvement have been tried with variable success. The surgical procedure presented here seems to offer a promising alternative. Drainage of the intraretinal fluid resulted in collapsing of the schisis‐like separation, and thus interrupted the continuous flow into the subretinal space. After the schisis‐like separation was closed, the subretinal fluid was resorbed. Complete resorption took several months, indicating that the central retinal detachment had been present for a long time. During the follow‐up of 29 months, no reopening of the schisis‐like separation occurred, even though the retinal incision is likely to have closed in the meantime. It might be assumed that once the schisis has collapsed, it will not separate again. Recently, Spaide et al2 reported successful retinal incision in optic pit maculopathy in a patient with schisis‐like cavity of the inner retina. The patient presented in our study shows that pathological fluid accumulation can be successfully drained even if it is located in deeper retinal layers such as the outer plexiform layer, resulting in disappearance of the schisis‐like separation.

In conclusion, if there is evidence for intraretinal fluid accumulation in a patient with optic pit maculopathy, internal drainage procedure might be considered regardless of the depth of the affected retinal layer.

Footnotes

Competing interests: None declared.

References

1. Lincoff H, Lopez R, Kreissig I. et al Retinoschisis associated with optic nerve pits. Arch Ophthalmol 1988. 10961–67.67 [PubMed]
2. Spaide R F, Fisher Y, Ober M. et al Surgical hypothesis: inner retinal fenestration as a treatment for optic disc pit maculopathy. Retina 2006. 2689–91.91 [PubMed]

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