Optic disc pit

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Summary of Evidence

Incidence of maculopathy

The general incidence of maculopathy in optic disc pit (ODP) is 51%, and the rate of serous macular detachment and retinoschisis is 49% and 58%, respectively. {Meng L, Zhao X, Zhang W, Wang D, Chen Y. The characteristics of optic disc pit maculopathy and the efficacy of vitrectomy: a systematic review and meta-analysis. Acta Ophthalmol. 2021 Nov;99(7):e1176-e1189.}

Vitrectomy

There were no significant differences in outcomes among 6 different surgical techniques in the treatment of optic pit maculopathy. {Zheng A, Singh RP, Lavine JA. Surgical Options and Outcomes in the Treatment of Optic Pit Maculopathy: A Meta-analysis and Systematic Review. Ophthalmol Retina. 2020 Mar;4(3):289-299.}

 

  • PPV alone
  • PPV plus juxtapapillary laser treatment (JPL)
  • PPV plus internal limiting membrane peeling (ILMP)
  • PPV plus both ILMP and JPL
  • PPV plus inner retinal fenestration
  • PPV plus autologous platelet concentrate

Evidence

1. General

Review

2020 Wan & Chang

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2020
Review

Review of pathogenesis, clinical presentation, diagnosis and treatment options of optic disc pit. {Wan R, Chang A. Optic disc pit maculopathy: a review of diagnosis and treatment. Clin Exp Optom. 2020 Jul;103(4):425-429.}

Review

2019 Kalogeropoulos et.al.

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2019
Review

Summary of the potential pathogenesis, diagnostic and therapeutic approach of optic disc pit maculopathy. {Kalogeropoulos D, Ch’ng SW, Lee R, Elaraoud I, Purohit M, Felicida V, Mathew M, Ajith-Kumar N, Sharma A, Mitra A. Optic Disc Pit Maculopathy: A Review. Asia Pac J Ophthalmol (Phila). 2019 May-Jun;8(3):247-255.}

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Review

2019 Uzel & Karacorlu

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2019
Review

Review of optic disc pit and optic disc pit maculopathy. {Uzel MM, Karacorlu M. Optic disk pits and optic disk pit maculopathy: A review. Surv Ophthalmol. 2019 Sep-Oct;64(5):595-607.}

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Review

2015 Moisseiev et.al.

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2015
Review

Review of mechanisms of pathogenesis in optic disc pit maculopathy (ODP-M), treatment modalities and their results. {Moisseiev E, Moisseiev J, Loewenstein A. Optic disc pit maculopathy: when and how to treat? A review of the pathogenesis and treatment options. Int J Retina Vitreous. 2015 Aug 7;1:13.}

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1.1 Optic disc pit maculopathy and other complications

Systematic review

2021 Meng et.al.

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2021
Systematic review

Systematic review of 59 studies on characteristics and treatment options of optic disc pit maculopathy.

 

  • The general incidence of maculopathy in optic disc pit (ODP) is 51%, and the rate of serous macular detachment and retinoschisis is 49% and 58%, respectively.
  • The incidence of sub-retinal fluid (SRF) only is 10%, intra-retinal retinal (IRF) fluid only is 14%, and SRF plus IRF is 69%
  • The incidence of posterior vitreous detachment (PVD), vitreo-papillary traction and vitreomacular traction (VMT) is 7%, 28% and 13%, respectively. {Meng L, Zhao X, Zhang W, Wang D, Chen Y. The characteristics of optic disc pit maculopathy and the efficacy of vitrectomy: a systematic review and meta-analysis. Acta Ophthalmol. 2021 Nov;99(7):e1176-e1189.}

2. Vitrectomy

Systematic review

2021 Meng et.al.

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2021
Systematic review

Systematic review of 59 studies on characteristics and treatment options of optic disc pit maculopathy.

 

  • The rate of complete anatomic success and visual improvement after pars plana vitrectomy are both around 85%.
  • Subgroup analysis reveals the anatomic, and visual success rates of PPV alone are 89% and 100%, respectively.
  • Gas tamponade, laser or internal limiting membrane peeling (ILMP) during vitrectomy are less promising, while PPV with ILM flap stuffing could achieve better outcomes than cases without it. {Meng L, Zhao X, Zhang W, Wang D, Chen Y. The characteristics of optic disc pit maculopathy and the efficacy of vitrectomy: a systematic review and meta-analysis. Acta Ophthalmol. 2021 Nov;99(7):e1176-e1189.}

Systematic review

2020 Zheng et.al.

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2020
Systematic review

Systematic review of 26 studies on surgical management of optic disc pit maculopathy.

  • 6 commonly reported techniques were identified:
    • PPV alone
    • PPV plus juxtapapillary laser treatment (JPL)
    • PPV plus internal limiting membrane peeling (ILMP)
    • PPV plus both ILMP and JPL
    • PPV plus inner retinal fenestration
    • PPV plus autologous platelet concentrate
  • All groups demonstrated improved best-corrected visual acuity compared with baseline, with no differences between groups
  • The average OPM resolution rate was 70%, and the average time to resolution was 8.4 months for all groups
  • Central macular thickness was reduced in all groups with no differences between groups
  • Tamponade had no effect on outcomes{Zheng A, Singh RP, Lavine JA. Surgical Options and Outcomes in the Treatment of Optic Pit Maculopathy: A Meta-analysis and Systematic Review. Ophthalmol Retina. 2020 Mar;4(3):289-299.}

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Review

2020 Theodossiadis et.al.

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2020
Review

Review of new treatment modalities for ODP maculopathy, specifically on covering and stuffing of the ODP.

 

  • Vitrectomy seems to be more successful if it is associated with the covering of the ODP by internal limiting membrane (ILM) inverted flapping
  • Another new procedure aims at the stuffing of the ODP by rolled ILM-flap, autologous scleral tissue or human amniotic membrane, providing promising anatomical results. {Theodossiadis G, Theodossiadis P, Chatziralli I. Thoughts and Challenges for the Current Treatment of Optic Disc Pit Maculopathy. Semin Ophthalmol. 2020 May 18;35(4):232-236.}

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References

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