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Multicenter Study of Pars Plana Vitrectomy for Optic Disc Pit

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Multicenter Study of Pars Plana Vitrectomy for Optic Disc Pit Eye (2017) 31, 1266–1273 © 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved 0950-222X/17 www.nature.com/eye 1 2 3 4 5 CLINICAL STUDY Multicenter study of R Avci , Z Kapran ,S¸ Ozdek , MY Teke ,OOz, D Guven6, S Yilmaz1, B Kaderli7, AH Durukan8, pars plana vitrectomy G Sobaci9, YB Unver10, L Akduman11, for optic disc pit S Kaynak12, I Dogan13 and UU Inan14 maculopathy: MACPIT study Abstract 1Department of Ophthalmology, Retina Eye Hospital, Bursa, Turkey Purpose To evaluate surgical intervention except an arcuate scotoma or enlarged blind spot 2Department of Ophthalmology, Maltepe University Medical School, with pars plana vitrectomy (PPV) for in some cases. However, vision deteriorates if Istanbul, Turkey correction of optic disc pit maculopathy optic disc pit maculopathy (ODP-M) consisted 3Department of Ophthalmology, Gazi (ODP-M). mainly of serous macular detachment or University Medical School, Ankara, – Turkey Patients and methods Retrospective chart macular schisis develops.2 6 4Department of Ophthalmology, review from 13 centres of 51 eyes of 50 Although pars plana vitrectomy (PPV) is Ulucanlar Eye Education and Research Hospital, Ankara, Turkey patients with ODP-M who underwent PPV generally accepted as the standard procedure for – fi 5Department of Ophthalmology, Adana between 2002 2014. Anatomic and nal best- the management of ODP-M, the need for various – Retina Eye Center, Adana, Turkey corrected visual acuity (BCVA) outcomes adjuvant therapies has not been well studied.4 10 6Department of Ophthalmology, Sisli were evaluated for all cases with different Etfal Education and Research Hospital, The current study was designed in an attempt to Istanbul, Turkey adjuvant techniques. pool the data from multiple centers due to the 7Department of Ophthalmology, Results There were 23 males and 27 females rarity of this condition and the need for larger Uludag University Medical School, Bursa, Turkey with median age 25.5 (6–68) years. numbers to determine effective treatment 8Department of Ophthalmology, Preoperative median foveal thickness was methods. Gulhane Military Medical Academy, – μ Ankara, Turkey 694.5 (331 1384) m and improved to 252.5 (153–1405) μm. Median BCVA improved from 9Private Practice, Ankara, Turkey Materials and methods 20/200 (20/20000 to 20/40) to 20/40 (20/2000 to 10Department of Ophthalmology, International Kolan Hospital, Istanbul, 20/20) with 20/40 or better in 31 eyes. This multicentre investigation (MACPIT Study) Turkey Complete retinal reattachment was achieved consists of interventional consecutive cases from 11Department of Ophthalmology, Saint Louis University Medical School, in 44 eyes (86.3%) at 7.1 (5.9) months. The 13 tertiary centres. The study was organized by Missouri, USA good surgical outcomes were achieved in the Society of Vitreoretinal Surgery of the 12Department of Ophthalmology, Dokuz Eylul University Medical School, different adjuvant groups. Median follow-up Turkish Ophthalmological Association. A total Izmir, Turkey was 24 (6 to 120) months. of 51 eyes were included in this retrospective 13Department of Biostatistics, Kocatepe Conclusions These results confirm the long- interventional case study. The patients were University Medical School, Afyonkarahisar, Turkey term effectiveness of PPV for ODP-M. treated with a PPV procedure between January 14Department of Ophthalmology, Prospective studies are needed to determine 2002 and December 2014. The patients selected Kocatepe University Medical School, Afyonkarahisar, Turkey the effectiveness of any adjuvant technique for inclusion in the study had complete optical Correspondence: in improving the success of PPV for ODP-M. coherence tomography (OCT) recordings and R Avci, Ophthalmology, Retina Eye Eye (2017) 31, 1266–1273; doi:10.1038/eye.2017.142; follow-up of at least 6 months. The main Hospital, Sanayi Cad No:171, Nilufer, Bursa 16600, Turkey published online 21 July 2017 outcome measures were complete reattachment Tel: +90 5323971719 or +90 224 2402400 01 02; of the macula, improvement in central macular Fax: +90 224 2402403. thickness (CMT) and visual acuity. E-mail: [email protected] Introduction Optic disc pits (ODPs) have long been This study was presented in part as a Procedure free paper in EURETINA meeting in recognized as congenital abnormalities of the Hamburg, 2013, at Turkish-Israel Joint 1 Meeting in EURETINA meeting in optic nerve head. The prevalence of congenital After core vitrectomy, the posterior hyaloid was Hamburg, 2013 and presented in part ODP is estimated at 1 in 11 000 ophthalmic removed. Triamcinolone acetonide (TA) was fi as a scienti c poster at the 31st 1,2 Annual Meeting of American Society patients. Males and females are affected used to ensure the complete removal of any of Retinal Specialists, 24–28 August equally. Optic disc pits are usually unilateral, vitreous residue in 28 eyes. Fluid-air exchange 2013, Toronto, ON, Canada. but may occasionally occur in both eyes.1 In was performed, followed by gas tamponade Received: 7 November 2016 isolated cases without macular involvement, fl Accepted in revised form: 19 June 2017 with sulphur hexa uoride (SF6) or Published online: 21 July 2017 prognosis is good with normal visual acuity perfluoropropane gas (C3F8). Postoperative Vitrectomy for optic pit maculopathy R Avci et al 1267 facedown positioning for ~ 1 week was recommended by correction. The Friedmann test was used to detect all surgeons. Thirty-four patients had C3F8 and 13 had statistical differences between the repeated SF6 and 2 had C2F6 gas tamponade. ILM peeling was measurements. All tests were two-sided. Descriptive data performed in 18 eyes and JLP was performed in 35 eyes. were summarised as median and range if the data are not normally distributed. A value of Po0.05 was considered statistically significant. Categorical grouping of collected cases A record was made of the use of intraoperative Results triamcinolone for better visualization and removal of the vitreous, the application of 180° juxtapapillary endolaser The data charts of 51 eyes of 50 patients with ODP-M photocoagulation (JLP) in mild-to-moderate intensity to undergoing PPV were reviewed. The patients were 23 the retina in the temporal margin of the optic disc prior to males and 27 females with median age of 25.5 years the fluid-air exchange, implementation of internal limiting ranging in age from 6 to 68 years. All patients had noted a membrane (ILM) peeling, and the type of intraocular central scotoma or metamorphopsia, and a decline in tamponade as well as intraoperative events and Snellen visual acuity was observed in all eyes prior to complications. The patients were then divided into four surgical intervention. The right eye was affected in 28 main categories according to the adjunctive techniques. patients, the left eye in 21 patients and 1 patient had Anatomical and functional results were evaluated in the bilateral ODP-M. Characteristics of the all eyes were following groups: C3F8 or SF6 tamponade group, JLP or summarized in Table 1. no JLP application group, ILM peeling or no ILM peeling An OCT evaluation of the eyes before surgery revealed group, and intraoperative TA use or no TA use group. double-layer separation in 42 eyes, pure intraretinal separation in two eyes, serous macular detachment (SMD) in 10 eyes and outer layer hole in 8 eyes. One eye Data review had a lamellar macular hole at baseline. The time from the The clinical features, surgical characteristics, surgical and onset of visual symptoms to surgery ranged from 2 weeks visual outcomes of the collected cases were analysed. The to 60 months (mean ± SD: 11.7 (16.3) months; median: preoperative data were collected for demographics (age 2.75 months). The vitreoretinal technique was 23-gauge in and gender), laterality, presenting visual symptoms and 34 eyes, 20-gauge in 11 eyes and 25-gauge in 6 eyes. best-corrected visual acuity. The postoperative data Complete resolution (CR) was observed in 44 of 51 eyes included the type of surgery performed, intraocular or (86.3%). The time to CR was mean (SD) 7.1 ± 5.9 months postoperative complications, repeated surgery and follow- and median 5 months (range, 1–20 months). Thirty eyes up examinations. All the data were collected via a (58.8%) showed CR within 6 months, while 13 eyes (25.5%) retrospective chart review. Optical coherence tomography resolved at month-12 and thereafter. Complete resolution was performed before and at each visit after the surgery. was determined at 18 months or later in 4 eyes (Figure 1) Spectral domain OCT was used in the majority of cases. If and 5 eyes showed partial resolution. Central macular the data were obtained by Time Domain OCT, 50 μmwas thickness did not decrease in 2 eyes. Of the five eyes that added to the CMT.11 A reduction of more than half of showed failure to CR, three had 12-month follow-up. baseline CMT over time was used as a marker of partial Preoperative median BCVA and CMT improved from resolution or partial anatomical success. The disappearance 20/200 and 700 μm to 20/40 and 257 μmatthefinal visit, of all the fluid in retinal compartments was defined as respectively. A gain of 2 or more Snellen lines of vision was complete resolution (CR) or complete anatomical success. determined in 43 (84%) eyes and 31 (61%) reached to 20/40 Best-corrected Snellen visual acuities were recorded. or better visual acuity. A mean (SD) improvement of 6.19 Snellen visual acuities were converted to the logarithm of (5.82) lines by ETDRS chart was obtained. Improvement in the minimum angle of resolution (logMAR) scale for BCVA and CMT was statistically significant (Po0.001). statistical analysis. Informed consent for surgery was Initial visual acuity stabilized or improved in all except two obtained from each patient after providing a complete eyes. Both of these eyes had undergone a second explanation of PPV procedure and natural course of the intervention, for macular hole in one eye and for recurrence ODP-M.
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