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Gas Tamponade Combined with Laser Photocoagulation Therapy Eye (2015) 29, 106–114 & 2015 Macmillan Publishers Limited All rights reserved 0950-222X/15 www.nature.com/eye 1,4 1,4 1,4 1 1 2 CLINICAL STUDY Gas tamponade L Lei ,TLi , X Ding ,WMa, X Zhu , A Atik , YHu1 and S Tang1,3 combined with laser photocoagulation therapy for congenital optic disc pit maculopathy Abstract Purpose To evaluate the long-term clinical Introduction efficacy and safety of gas tamponade Optic disc pit (ODP) is part of a spectrum of combined with laser photocoagulation for congenital cavitary optic disc anomalies which optic disc pit maculopathy. was seen in o1/11 000 patients.1 The pit lesions Methods Seven consecutive patients with are typically unilateral, oval, and gray-white unilateral maculopathy associated with 1State Key Laboratory of depressions located in the temporal segment of optic disc pit and one patient with bilateral Ophthalmology, Zhongshan the optic disc and frequently involve the macula Ophthalmic Center, Sun Yat- optic disc pit maculopathy were given via intra-retinal and sub-retinal fluid collections.2 sen University, Guangzhou, octafluoropropane (C3F8) tamponade Visual acuity and visual fields are normal unless China combined with focal laser photocoagulation associated with serous macular detachment. treatment. Patients were followed up for 2Royal Victorian Eye and Ear The mechanisms underlying this disease are 21–62 months after treatment. Main Hospital, Melbourne, VIC, unclear, especially in relation to intra-retinal Australia outcomes were determined by optical coherence tomography (OCT) and best- and sub-retinal fluid accumulation. ODP maculopathy (ODPM) was first described by 3Aier School of corrected visual acuity (BCVA). Halbertsma1, with macular changes including Ophthalmology, Central Results Treatment with C3F8 tamponade South University, Changsha, followed by laser photocoagulation in ODP serous detachment, cystic degeneration, and China maculopathy patients resulted in resolution of degenerative pigment retinopathy. Serous sub-retinal and/or intra-retinal fluid in six out macular detachment or schisis develops in Correspondence: B25–75% of patients with visual deterioration.3 S Tang, Aier School of of eight patients. The remaining two patients Although spontaneous reattachment has been Ophthalmology, Central had significant reduction in fluid, as 4,5 South University, Floor 4, determined by OCT, and funduscopy, as well reported, the prognosis of ODPM is poor if 6 New Century Building, as an improvement in anatomical architecture. left to its natural course. Several therapeutic 198# Furong Middle Road, Visual acuity improved obviously in seven approaches have been attempted, but responses Changsha 410015, have been variable. A relatively high incidence Hunan, China. eyes and remained stable in two eyes. Central Tel: +86 0731 85179288 visual field loss after photocoagulation was of recurrence has been reported after 8809; not clinically appreciable by visual field conventional laser photocoagulation or gas Fax: +86 0731 82570202. examination. No post-operative complications tamponade alone.7–9 Vitrectomy with or without Email: tangshibo@ of maculopathy occurred during the follow- a combination of laser treatment and/or gas vip.163.com tamponade has been reported to be an effective 4These authors contributed up period. 10–13 equally to this work and are Conclusions Although repeated treatment treatment and is widely used. However, the to be considered as first co- was needed in some patients, C3F8 potential complications of vitrectomy in ODPM authors. tamponade combined with laser patients (eg, macular hole),11 and controversy photocoagulation is still a simple, effective, surrounding appropriate adjunct procedures Received: 31 July 2014 minimally invasive, and economic therapy (eg, induction of posterior vitreous detachment Accepted in revised form: 15 September 2014 for optic disc pit maculopathy. (PVD) or internal limiting membrane (ILM) Published online: 17 Eye (2015) 29, 106–114; doi:10.1038/eye.2014.245; peeling) means that there is still no standard October 2014 published online 17 October 2014 treatment for ODPM. Combined therapy for congenital optic disc pit maculopathy L Lei et al 107 Lincoff9 described the association between ODP and electroretinogram (mfERG) conducted pre and schisis-like separation of the macula. He suggested that postoperatively. fluid initially enters the retinal stroma to form a schisis, All surgery was performed at the Zhongshan and then enters the sub-retinal space to eventually cause Ophthalmic Center by the same retinal specialist. a serous retinal detachment. However, the precise origin Intravitreal gas injection was given under topical of the sub-retinal fluid remains elusive. Several possible anesthesia after obtaining informed consent. Paracentesis sources have been suggested, including cerebrospinal and discharge of 0.05–0.08 ml acqueous humor was 3,14 fluid, liquefied vitreous, or leaky vessels at the base of followed by injection of 0.5 ml of 66% C3F8 gas into the the pit.2 Postel et al15 also observed some cases with a vitreous cavity. After this procedure, the patients were subtle tear in the diaphanous tissue overlying the optic asked to maintain a face-down position for at least 8 h pit, suggesting a rhegmatogenous component to the per day for 2 weeks. Posterior pole retinal detachment. In either case, the sub-retinal fluid appears photocoagulation was performed 1–2 weeks to gain access to the macula via the anomalous optic postoperatively using a 532 nm wavelength laser nerve. (Oculight SL, Iris Medical Instruments, Mountain View, The advent of optical coherence tomography (OCT) CA, USA). Two to three rows of 100-mm spot size burns has allowed a greater understanding of the were placed temporal and adjacent to the optic nerve to pathophysiology of ODPM.16 By using spectral domain span the juxtapapillary border of the retinal detachment OCT with eye tracking technology, studies have and the superior and inferior margins of the detached confirmed that fluid from the optic pit can go directly retina. Exposures of 0.1 s were used, and the power into the retina.16 We hypothesize that this macular fluid adjusted to cause Grade I–II gray burn at the level of can be blocked by forming a barrier in the region of the the retinal pigment epithelium. All the patients were pit and extending into the central macula. This barrier followed up on the 7th and 14th day post-gas tamponade can be achieved by hydrostatic pressure from intravitreal and then fortnightly for a month. Patients were then seen gas tamponade (which can force the absorption of the at 1, 3, 6, 12, 18, and 24 months postoperatively. The main macular fluid) and laser photocoagulation (which can outcome measures included BCVA and the status of cause full-thickness scarring of the retina along the retinal anatomic features on Stratus OCT (Carl Zeiss optic pit). Meditec Inc., Dublin, CA, USA), and Spectralis OCT Although combined treatment with gas tamponade (Heidelberg Engineering, Heidelberg, Germany). and laser has previously been reported,17,18 these studies Tracking technology with Spectralis OCT was used to performed laser first followed by gas tamponade and assess the progress of maculopathy and parameters, such only had small case series and short-term follow-up. as foveal and macular thickness, and macular volume Thus, we report the first long-term clinical study on the were recorded to evaluate the efficacy of the treatment. safety and efficacy of gas tamponade using Patients were given repeated treatment if maculopathy octafluoropropane (C3F8) combined with laser such as serous detachment or schisis still existed or once photocoagulation in patients with retinoschisis and again became severe. serous macular detachment due to congenital ODP. Data analysis was performed with SPSS statistical software version 16.0 (SPSS Inc., Chicago, IL, USA). Paired- and independent-sample t-tests were used to Materials and methods compare group differences. A P-valueo0.05 was This case series was conducted at the Zhongshan considered statistically significant. Ophthalmic Center of the Sun Yat-sen University in Guangzhou, China and was approved by the Institution Review Board (IRB) of Zhongshan Ophthalmic Center. Results Prior to the medical procedures, the written informed Clinical characteristics consents were obtained from the participants or the guardians on behalf of the minors/children enrolled in The clinical characteristics of all eight patients are shown our study. Nine eyes of eight patients with identified in Table 1, while clinical photographs of representative reduction of vision due to ODPM were included in the patients are shown in Figures 1 and 2. The patients were study. We confirmed ODP based on clinical evidence, 11–38 years of age (mean, 25.8) and included four females including patient symptoms, fundus changes, OCT and and four males without any family history of ODP. The fundus fluorescein angiography (FFA). Best-corrected mean follow-up period in this study was 39.6 months visual acuity (BCVA), OCT and fundus photography (range 21–62 months). All patients reported decreased were undertaken pre and postoperatively in each patient. VA or metamorphopsia in the affected eye. The duration Some patients also had visual fields, FFA and multifocal of defective vision was from 2 days to 21 months. Eye 108 Eye Combined therapy for congenital optic disc pit maculopathy Table 1 Clinical information of patients Pts Age/eye/ Symptoms Duration Pit location Refractive Initial C/D ratio Posterior Macular
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