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Jean-Baptiste Deltour, Olivier Lebreton, Hélène Masse, Michel Weber; Successful use of a silicone lacrimal plug to treat a case of refractory serous macular detachment complicating a large optic disk pit.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5933.
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© ARVO (1962-2015); The Authors (2016-present)
Optic disc pit is a rare congenital anomaly resulting from imperfect closure of the embryonic fissure. Serous macular detachment is the most common complication causing visual loss in 75% of these patients. There is currently no universally accepted gold standard of treatment for this condition. In the presence of serous macular detachment, a strategy combining pars plana vitrectomy, ILM peeling, laser photocoagulation and gas tamponade is often offered as first-line therapy. In refractory cases, several surgical alternatives have been recently described to seal the optic disc pit like scleral autograft, ILM free flap or fibrin sealant.Herein, we report a case of large refractory optic disc pit maculopathy successfully treated by a novel surgical technique using a silicone lacrymal plug.
A 43-year-old female with a long-standing history of unilateral optic disc pit maculopathy was referred to our clinic. Her visual acuity was limited to 20/800 in the left eye because of refractory serous macular detachment for 2 years despite laser photocoagulation and two vitrectomy procedures with ILM peeling and C2F6 tamponade.SD-OCT imaging revealed a large pit mesuring more than 900 μm in horizontal diameter and extended in depth over 1500 μm in the optical disk. The optic disc pit communicates with a wide sub-retinal fluid cavity that lifts the macula.We decided to use a silicone lacrimal plug to fill the pit and thus mechanically prevent the penetration of subretinal fluid. The punctual plug was inserted into the vitreous cavity by a 20-gauge sclerotomy during a 23G pars plana vitrectomy. The positioning of the plug in the pit was performed with a 23G epiretinal membrane forceps. Finally, a 20% SF6 tamponade was performed to maintain the plug after fluid-air exchange.
This unprecedented procedure allowed an excellent anatomical result with a total resolution of serous retinal detachment in 1 month.Unfortunately, functional gain was low due to structural alterations of the outer retina previously induced by prolonged serous detachment. Visual acuity remained stable at 6 months.
This case suggests that silicone punctal plug can be considered as an interesting option in the surgical treatment of large optic disc pit-associated maculopathy. The functional benefit of this technique needs to be assessed in larger cohorts.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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