Abstract
Purpose :
There is no consensus on the optimal treatment of serous macular detachments associated with optic disc pits. Current treatment options are controversial and have variable success, including laser photocoagulation, pars plana vitrectomy with gas tamponade, and inner retinal fenestration. The purpose of this study is to report the successful treatment of four patients with optic pit maculopathy with intraocular pressure (IOP)-lowering modalities alone.
Methods :
Retrospective review of consecutive patients with serous macular detachment associated with cavitary optic disc anomalies who were treated at a single quaternary care institution between January 2018 and November 2023. Patient data included Snellen best corrected visual acuity, IOP, optical coherence tomography (OCT), and clinical assessment of intraretinal and subretinal fluid (IRF and SRF). All patients were initiated on topical IOP-lowering agents. IRF and SRF were assessed at follow-up visits, and additional topical, oral, laser and surgical IOP-lowering interventions were initiated until SRF resolution was achieved.
Results :
Four eyes of 4 patients were included. No patient had a prior history of glaucoma. Mean IOP at presentation was 17.5 mmHg (range 15-22 mmHg). Complete resolution of fluid was achieved in 3 of the 4 patients at a mean reduction in IOP of 18.7% with an average of 3.3 IOP-lowering agents after 6 months (range 1-12 months) (Figure 1). SRF reduction was seen in the fourth patient with a 33% reduction in IOP on 3 agents at most recent follow up of 6 months. One patient had recurrent subretinal fluid following cessation of oral acetazolamide that resolved within a month of medication resumption, mimicking a challenge-dechallenge-rechallenge intervention. Sustained results were seen in this cohort for over 5 years with continued treatment.
Conclusions :
Conservative treatment with IOP management may be an effective treatment for patients with serous macular detachments associated with optic disc pits. IOP management may affect the intraocular fluid dynamics to allow for SRF resolution. A prospective controlled study with long-term follow up will be necessary to confirm the viability of this novel approach.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.