OSLI Retina

September 2018

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712 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C A S E R E P O R T ■ 27-Gauge Via Pars Plana Vitrectomy With Autologous ILM Transplantation for Optic Pit Disc Maculopathy Tomaso Caporossi, MD; Lucia Finocchio, MD; Francesco Barca, MD; Fabrizio Franco, MD; Ruggero Tartaro, MD; Stanislao Rizzo, MD ABSTRACT: To report a case of a serous macular detachment associated with optic pit that did not improve after a previous vitrectomy with internal limiting membrane (ILM) peeling, peripapillary la- ser, and gas tamponade. The authors performed a lens-sparing 27-gauge pars plana vitrectomy with autologous transplantation of ILM inside the optic nerve pit and gas tamponade. The subretinal fluid gradually resolved and visual acuity improved to 20/20 at the tenth month after surgery. The authors did not observe a recurrence of subretinal fluid dur- ing the 14 months of follow-up. Autologous trans- plantation of the ILM may be effective to repair re- curring optic disc pit maculopathy. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:712-714.] INTRODUCTION Optic disc pits (ODPs) have long been recognized as congenital abnormalities of the optic nerve head. 1 Mac- ular changes can occur in the context of an ODP (optic disc pit maculopathy [ODP-M]) and include intraretinal or subretinal fluid accumulation and retinal pigment changes. 2 Although some reports describe spontaneous resolution of the subretinal fluid with improved vision, most eyes lose vision within the first 6 months with fi- nal visual acuity (VA) of 20/200 or worse. 1 The predominant approach for the treatment of ODP-M is pars plana vitrectomy (PPV) with induc- tion of posterior vitreous detachment, internal limiting membrane (ILM) peeling, peripapillary laser, fluid-air exchange, and gas or silicone oil tamponade. 2-4 An alter- native technique with macular buckling, active drain- age of subretinal fluid with a small gauge cannula has been described, but it is rarely used. 3 Other techniques designed to seal the ODP include inverting peeled ILM into the ODP 5 and using Tisseel fibrin sealant (Baxter Healthcare, Deerfield, IL). 6 CASE REPORT In June 2016, a 27-year-old male was referred to our retinal clinic in Florence, Italy, with a serous macular detachment related to optic pit in the right eye. In 2007, the patient underwent vitrectomy with induced pos- terior hyaloid detachment, ILM peeling, peripapillary laser, and gas tamponade, but he developed subretinal fluid and his VA was worse a few years after surgery (Figure 1). He was phakic with clear lens status and his VA was 20/50 with no refractive errors in both eyes. Fun- dus examination showed a serous macular detachment with an optic nerve coloboma. There was peripapil- lary atrophy due to the previous laser treatment. Opti- cal coherence tomography confirmed the status of the macular detachment. We performed a lens-sparing 27-gauge PPV. The status of the posterior hyaloid was checked by staining the vitreous with triamcinolone acetonide. The posterior hyaloid was removed all over the posterior pole as far as the vascular arcades. With the vitrectomy probe, we extended the posterior hya- loid detachment to the medium retinal periphery. We used MembraneBlue-Dual (Brilliant Blue G + Trypan Blue; D.O.R.C., Zuidland, The Netherlands) to stain the ILM remnants in the posterior pole. All the ILM on the posterior pole had already been peeled, and we had to harvest the ILM beyond the vascular arcades. Holding From the Department of Translational Surgery and Medicine, Ophthalmol- ogy, University of Florence, Careggi, Florence, Italy. Originally submitted January 2, 2018. Revision received June 24, 2018. Accepted for publication August 3, 2018. The authors report no relevant financial disclosures. Address correspondence to Lucia Finocchio, MD, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, 3 - 50134 Firenze Italy; email: lucia- finocchio@gmail.com. doi: 10.3928/23258160-20180831-10

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