Swept-Source OCT and Swept-Source OCT Angiography before and after Vitrectomy with Stuffing of the Optic Pit

Abstract

Purpose: To identify swept-source (SS) OCT and SS OCT angiography (OCTA) patterns predicting outcome in patients with optic disc pit-associated maculopathy and to present the results of a novel surgical technique, stuffing of the optic disc pit.

Design: Prospective, interventional study.

Participants: Fifteen eyes.

Methods: Swept-source OCT before surgery and then 1 week and 1, 3, and 6 months after surgery, then up to 4 years later. Swept-source OCTA was performed from 2015 (9 patients). After core vitrectomy, internal limiting membrane (ILM) was peeled between the optic nerve and fovea and stuffed into the optic disc pit. Laser photocoagulation was performed at the temporal side of the optic disc pit. Fluid-air exchange followed. The following data were noted: visual acuity, central retinal thickness, distribution of fluid on SS OCT, and diameters and circuit of the foveal avascular zone on OCTA.

Main outcome measures: Normalization of the fovea contour and visual acuity.

Results: We subdivided patients into 2 groups. On SS OCT, we observed subretinal fluid with elevation of the fovea (group 1) in 8 eyes. Group 2 comprised 7 eyes without subretinal fluid, but with intraretinal fluid. Five of these eyes additionally showed an outer lamellar macular hole. Anatomic success was achieved in all eyes. The decrease of central retinal thickness 1 week after surgery was more marked in group 1 (P = 0.002). The area of the foveal avascular zone in the superficial retinal vessel layer increased significantly after surgery for group 2 (P = 0.04), but not for group 1 (P = 0.4). Visual acuity improved without statistically significant differences between groups.

Conclusions: Stuffing of the optic disc pit with the ILM results in improvement of anatomic and functional results. Prognosis depends on initial morphologic features. Central retinal thickness normalizes faster after surgery in eyes with subretinal fluid when compared with eyes with intraretinal fluid. Faster anatomic improvement does not correlate with improvement of vision. Postoperative increase in the size of the foveal avascular zone in the superficial retinal vessel layer, more pronounced in group 2, may be associated with the prolonged postoperative anatomic recovery in those eyes.