• Effective Treatment Options for Optic Pit Maculopathy

    The key to treating optic pit maculopathy may lie in creating an effective intraretinal barrier to prevent fluid migration, according to Mark Johnson, MD.

    At Friday’s Retina Subspecialty Day, Dr. Johnson presented an overview of and effective treatment options for this rare congenital anomaly, which is characterized by intraretinal and subretinal fluid at the macula.

    What are the main features? Schisis-like intraretinal cavities connecting with the optic disc and allowing passage of fluid is a nearly universal feature of this disease, according to Dr. Johnson. In most eyes, the fluid eventually accumulates in the subretinal space. Rarely, physicians may encounter subretinal fluid alone.

    Clues point to fluctuating pressure gradients. Dr. Johnson hypothesized that fluctuating pressure gradients within the cavity could be the underlying cause of fluid migration into the adjacent tissue. Evidence to support this claim includes a study that employed optical coherence tomography (OCT) and observed vitreous debris moving in and out of the cavity when digital pressure was applied to the globe.

    Effective surgical approaches. A permanent cure may require a barrier to intra- and subretinal fluid migration from disc cavitation. He discussed several surgical approaches, including the following:

    • Macular buckle. Several groups have reported excellent outcomes with this technique. It is not widely adopted, however, as most surgeons are uncomfortable with this procedure.
    • Vitrectomy alone. Vitrectomy alone without gas or laser can offer a slow but effective resolution in 90% of eyes. Unfortunately, real-world data suggest that recurrence is very common with this approach.
    • Combined titrated laser photocoagulation and vitrectomy. The procedure involves carefully titrated juxtapapillary laser photocoagulation followed by vitrectomy and gas tamponade and postoperative facedown positioning (7-10 days). A small study showed fluid resolution in all patients and recurrence of macular fluid in 9%. Vision improved from 20/125 to 20/57. Possible complications include laser-induced cecocentral scotoma.

    Finally, through a series of 3 cases, Dr. Johnson showed how an effective intraretinal barrier to fluid migration can permit resolution of macular fluid, thus preventing recurrent maculopathy over a long follow-up. OCT can offer an effective way to assess the integrity of barrier formation postoperatively, he concluded.—Keng Jin Lee

    Relevant financial disclosures: Dr. Johnson: Hoffman-LaRoche: S; Ohr: C; Pfizer, Inc.: C; Tyrogenex: C.

    Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.