Surgical management of optic pit maculopathy: controversies and caveats

摘要

Introduction: We know with reasonable clarity that the natural course of optic disc maculopathy is poor and laser photocoagulation alone fails to improve outcomes. Surgical management is therefore favored for most cases; optimum surgical treatment however remains controversial. This perspective attempts to evolve consensus from the evidence strewn in the literature, and proposes a rational management protocol. Areas covered: The literature on management of optic pit maculopathy leans towards vitrectomy, with or without additional procedures like laser photocoagulation, internal limiting membrane peeling and intraocular gas tamponade, though excellent outcomes have been reported with posterior scleral buckling. The authors conducted a search of the Medline database for all years using the keywords optic pit maculopathy, optic pit AND macular schisis, optic pit AND macular detachment; optic pit AND vitrectomy, optic pit AND laser photocoagulation, and included the pertinent articles. Expert commentary: While prospective randomized trials are probably not possible due to rarity of the condition, the minimal intervention which affords maximum outcomes appears to be vitrectomy and induction of posterior vitreous detachment: the quintessential first line of treatment. Any additional procedures should be kept in reserve for 6-12 months to allow for the slow anatomical and functional recovery.