Edited Film

Ana Sofia Lopes, Susana Henriques, Mario Ramalho, Graça Pires, Susana Teixeira, Portugal

Introduction & Purpose:
Optic Disc Pit (ODP) is a rare congenital anomaly of optic disc (OD), typically unilateral and sporadic, which can be complicated by maculopathy with decreased visual acuity (VA). The pathophysiological mechanism of maculopathy is still unclear and several techniques have been described in its approach. It is intended to present one of the surgical techniques in a case of maculopathy associated with ODP.

Material & Methods:
Video presentation of a clinical case of maculopathy associated with ODP, including the surgical techniques performed and also photos of the complementary exames before and after surgery.

Results:
A 34-year-old female patient with a history of myopia (-3.00D bilaterally) went to the emergency room due to a progressive decrease in VA of the left eye (LE) with 1 week of evolution, without precipitating factors. She had a better corrected visual acuity (BCVA) of 10/10 in the right eye (RE) and “finger count” in the LE, and normal biomicroscopy and intraocular pressure. RE fundoscopy was normal and in the LE was observed an ODP in the OD border, apparently continuous with macular serous detachment, changes confirmed by optical coherence tomography (OCT) of macula and DO. Macular detachment was characterized by the presence of fluid between the internal limiting membrane (ILM) and the remaining retinal layers, areas of retinoschisis and areas of neurosensorial detachment. In the OCT of the DO was observed a hyperreflective structure on the DO suggestive of gliosis, with potential local vitreoretinal (RV) traction, as well as a hyporreflective pit between the temporal border of the DO and the layers of the retina, in continuity with the intraretinal fluid. We opted for a surgical approach that would not only eliminate the local VR traction but also mechanically avoid the passage of fluid into the retinal space. Vitrectomy was performed via pars plana, mechanical detachment of the posterior hyaloid after injection of triamcinolone, ILM coat with aid of twin blue dye, followed by the “closure” of the pit with an inverted flap of MLI in the OD direction, contrary to the inflow of liquid to the retinal space. Air-fluid exchange, SF6 tamponade and sclerotomy closure were followed. No postoperative complications were observed. After 3 months, the patient presented a BCVA of 0.1, fundoscopy with reduction of macular serous detachment, confirmed by OCT. In the OCT of DO, the hyperreflective structure of potential VR traction was no longer visible and there was an apparent reduction in the communication between the ODP and the macular area.

Conclusion:
The clinical approach in cases of maculopathy associated with ODP is a real challenge, and the pathophysiological mechanisms involved are still uncertain. However, the introduction of new surgical techniques has paved the way for better success rates. The follow-up of this case may contribute to a better understanding of this pathology.

Contact Details:
Ana Sofia Lopes
Hospital Professor Doutor Fernando Fonseca
Lisboa
Portugal
Cell Phone : +351 933650965
Work Phone : +351 933650965
Email : anasofialopes16@gmail.com