Abstract
Purpose: :
Optic Nerve Pits are rare congenital colobomatous malfomations of the optic nerve head. Although they may remain asymptomatic, maculopathy may develop in 40 to 50 percent of cases. The optimal management of optic pit-related maculopathy remains challenging. This study aims to evaluate the management outcomes in optic nerve pit-related maculopathy.
Methods: :
Retrospective case series from 2003 to 2011 of fourteen (14) patients with optic nerve pit-related maculopathy who underwent surgical intervention with laser, gas injection, and/or vitrectomy.
Results: :
Fourteen patients (ages 5 to 65) were identified with symptomatic optic nerve pit-related maculopathy. The visual acuity at the time of presentation ranged from 20/20 to count fingers. Following treatment, the visual acuity ranged from 20/20 to count fingers. The treatment strategies ranged from laser (n=14), laser with gas injection (n=4), and vitrectomy (n=11). Six of fourteen patients who received laser monotherapy as the initial treatment experienced an initial decline in vision. In 2/14 cases, amblyopia may have limited the ultimate visual recovery despite anatomic success. In 2/14 cases, choroidal neovascular membranes developed which may have been a late complication from laser therapy. Amongst the patients which underwent vitrectomy, 8/11 patients ended up with equal or improved vision post-vitrectomy. There was one case of endophthalmitis following vitrectomy.
Conclusions: :
This case series suggests that laser as initial therapy may lead to further decline or fail to prevent a decline in visual acuity. Laser with gas injection or vitrectomy may yield better results as initial therapy as compared with laser alone. For young patients with optic nerve pit-related maculopathy, amblyopia may limit the vision recovery despite anatomic success.
Keywords: retinal detachment • optic nerve • vitreoretinal surgery