Current advances in the management of optic disc pit maculopathy

ABSTRACT

Introduction

Although we have been familiar with optic disc pits for a long time, the diagnosis and management of maculopathy remain unclear. Better imaging has improved the diagnosis of this subtle pathology. A recent update on the natural history of optic pit maculopathy marks a paradigm shift in the understanding and management of this condition. There is renewed scope for non-surgical management and less urgency for vitrectomy, which remains the definitive treatment.

Areas covered

This perspective highlights and critiques the updates on diagnostic imaging, natural history, indications and prognosis for surgery, non-surgical alternatives, and surgical adjuncts. We searched the Medline database using the keywords optic pit AND maculopathy, optic pit AND macular schisis, optic pit AND macular detachment; optic pit AND vitrectomy, optic pit AND laser photocoagulation, and included the salient articles.

Expert commentary

There has been no major change in the surgical options and outcomes for optic pit maculopathy in recent times, except a greater clarity on the role of vitrectomy without any adjuvants as the primary surgical procedure. The key updates are on better imaging for diagnosis and prognosis, and less urgency for surgery in view of the favorable natural history.

KEYWORDS:

• Diagnostic imaging
• macular detachment
• macular schisis
• natural history
• optic disc pit maculopathy
• optical coherence tomography
• pneumatic retinopexy
• posterior vitreous detachment

Article highlights

• There is a change in perspective about the natural course of optic disc pit maculopathy (ODP-M): we can wait and watch if the vision is good.

• There is a renewed scope for non-surgical options like pneumatic retinopexy and enzymatic vitreolysis in view of the favorable natural history of ODP-M.

• The improved imaging, especially optical coherence tomography (OCT), has elucidated the diagnosis, differential diagnosis, surgical rationale, postoperative prognosis, and the scope of re-surgery.

• There is a continued consensus on basic vitrectomy and removal of posterior vitreous cortex as the key surgical step in the treatment of ODP-M.

• There is an increasing array of surgical adjuvants – the most promising being fovea-sparing internal limiting membrane peeling with flap inversion and plugging the pit – which are best reserved for re-vitrectomy in refractory cases.

• Since prospective randomized trials may never be possible in this rare condition, multi-center international collaboration on one hand and individualized treatment on the other may be the best way to manage ODP-M.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.