OSLI Retina

October 2019

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October 2019 · Vol. 50, No. 10 649 ■ C A S E R E P O R T ■ Anterior Lens Capsule Transplantation for Acquired Optic Disc Pit Maculopathy Hiroyuki Nakashizuka, PhD, MD; Koichi Furuya, PhD, MD; Hajime Onoe, MD; Yu Wakatsuki, PhD, MD; Yumiko Machida, MD; Yorihisa Kitagawa, PhD, MD; Koji Tanaka, PhD, MD; Takayuki Hattori, MD; Ryusaburo Mori, PhD, MD ABSTRACT: A patient with acquired optic disc pit (ODP) maculopathy underwent vitrectomy with anterior capsule transplantation to the ODP and gas tamponade. Structural changes were evalu- ated by enhanced depth imaging optical coherence (OCT) tomography. During vitrectomy, the eye was confirmed to have preexisting posterior vitreous detachment. Postoperative OCT showed complete closure of the optic pit resulting in rapid absorp- tion of subretinal fluid. The authors' observations suggest that the anterior capsule is a useful mate- rial for achieving optic pit closure. To the authors' knowledge, this is the first report describing appli- cation of the anterior capsule to the treatment of ODP maculopathy. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:649-652.] INTRODUCTION Optic disc pit (ODP) is a congenital abnormality of the optic nerve head and may lead to macular de- tachment. In addition to the congenital type, acquired ODP secondary to glaucoma has also been described. 1 Enhanced depth imaging optical coherence tomogra- phy (OCT) was recently reported to show structural abnormalities involved in optic disc development in glaucomatous eyes associated with laminar holes or lamina cribrosa defects. 2 These findings suggest that subretinal fluid (SRF) due to acquired ODP originates from vitreous fluid, passing through the ODP, not from the subarachnoid space. In recent years, implantation of a piece of sclera, 3,4 internal limiting membrane (ILM) insertion into the ODP, 5,6 or the inverted ILM technique for the ODP 7 have been reported to achieve good results. Further- more, transplantation methods involving the anterior or posterior capsule for refractory macular hole (MH) treatment have also been reported. 8 Herein, we de- scribe a patient with acquired ODP maculopathy who underwent anterior capsule transplantation to close the ODP. CASE REPORT A 70-year-old woman had first noticed visual acu- ity (VA) loss in the right eye (OD) 3 years prior to pre- sentation. She became particularly aware of VA loss in November 2015. Her best-corrected VA (BCVA) at the first visit was 20/25 OD. The intraocular pressures were 12 mm Hg OD and 13 mm Hg in the left eye (OS). Cataracts (Emery-Little grade 2) were recognized in both eyes. Fundus examination showed an ODP in the lower part of the OD optic disc and a nerve fiber defect at the same site as the ODP (Figure 1A). This corresponded to a visual field defect on Humphrey visual field testing. OCT indicated retinoschisis and a retinal detachment extending from the optic disc to the macula (Figures 1B and 1C). ODP was confirmed by OCT and angio-OCT three-dimensional images (Figures 1B and 1D). Her BCVA OD deteriorated to 20/32, necessitating 27-gauge vitrectomy. Prior to vitrectomy, the patients underwent cata- ract surgery and anterior capsulorhexis was per- formed with anterior capsular forceps. The anterior capsule was removed from the eye and stained with 0.0625% Brilliant Blue G to avoid misplacing it. The capsule was then temporarily stored in a petri dish with BSS PLUS solution (Alcon, Fort Worth, TX). From Nihon University Hospital, Chiyoda-ku, Tokyo, Japan. Originally submitted December 4, 2018. Revision received March 3, 2019. Accepted for publication March 26, 2019. Paper presented at the 2018 Japanese Clinical Ophthalmology Meeting, Tokyo Japan, October 11-14, 2018. The authors report no relevant financial disclosures. Address correspondence to Hiroyuki Nakashizuka, PhD, MD, Nihon Uni- versity Hospital 1-6, Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8301, Japan; email: nakashizuka.hiroyuki@nihon-u.ac.jp. doi: 10.3928/23258160-20191009-08

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