The Pit Evolution Story: A tale of 4 pits

Author: Gagan Bhatia (India)

Co-authors: Cyrus Shroff, Charu Gupta, Daraius Shroff, Neelam Atri

Purpose

To report anatomical and functional outcomes of four cases of optic disc pit which underwent surgical intervention using four different techniques and to discuss variations in techniques as they have evolved over time.

Setting/Venue

A tertiary ophthalmic care and research centre

Methods

A retrospective interventional case series of 4 cases of optic disc pit maculopathy who underwent surgical intervention where four different surgical approaches were studied: • Case 1- A 42 year old man underwent vitrectomy with standard aracade to arcade ILM peeling and gas tamponade followed by laser to edge of disc . • Case 2- A 36 year old man underwent vitrectomy along with macular sparing ILM peel , stuffing of the disc pit and gas tamponade followed by laser. • Case 3- A 6 year old boy was taken up for vitrectomy with ILM peel (macula sparing ) , SRF drainage via 39 GAUGE soft tip needle and gas tamponade . • Case 4 -A 15 year old female underwent vitrectomy with hAMG grafting and macular sparing ILM peel with gas tamponade.

Results

Anatomical and functional outcomes of these four varying techniques were studied. A successful procedure was defined as complete resolution of the neurosensory detachment on OCT with improvement in vision. Case 1 - The BCVA improved to 6/60 from 6/120 at 6 weeks with slight decrease in NSD. Unfortunately, 6 months down the line the NSD increased with drop in vision to 3/60. Case 2 - Preoperative BCVA of 6/18, showed mild decrease in NSD at 6 weeks . Patient was observed and followed up regularly . At 3 months post op, after undergoing laser to edge of disc , with complete resolution of the NSD, the BCVA improved to 6/12. Case 3- The BCVA improved to 6/12, from 2/60 at 6 weeks with resolution of the NSD. Six months the fluid reappeared with drop in BCVA to 6/60 followed by spontaneous resolution of fluid and BCVA of 6/12 in the next 4 months and puzzling waxing and waning of SRF. Case 4- A dramatic complete resolution of the NSD on day 1 with visual improvement to 6/18 , from a preop BCVA of 6/24 . The status 3 months postoperatively was satisfactory and no fluid noted on OCT .

Conlusions

Optic disc pit surgical management has always been controversial with various techniques being described over the years. Persistent Fluid or late resolution and recurrences have always lead to doubts on the optimal procedure for disc pits . In this series of 4 cases we describe the surgical variations in management of optic disc pit maculopathy . The hAM Grafting technique seems promising with a more complete closure of the pit with fast and complete resolution of the NSD leading to better anatomical and functional improvement.

Financial Disclosure

NONE