Management of OPTic disc pIt MAculopathy

Purpose: To evaluate long-term anatomical and visual outcomes after pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) flap in the treatment of optic disc pit maculopathy (ODPM). Design: Multicenter, retrospective cohort study. Participants: Patients with congenital ODPM who underwent primary or revisional PPV with ILM flap, with a minimum follow-up of 12 months. Methods: Clinical data were retrospectively collected, including baseline characteristics, surgical details, fluid distribution, central macular thickness (CMT), and best-corrected visual acuity (BCVA) at baseline and at 1, 6, and 12 months postoperatively, as well as at the final follow-up. Main outcomes measures: The primary outcome was the rate of anatomical resolution (defined as complete reabsorption of intraretinal fluid and subretinal fluid [SRF]) at 12 months. Secondary outcomes included anatomical resolution at last follow-up, change in CMT and BCVA, fluid distribution patterns, and identification of predictors of treatment response. Results: A total of 71 eyes from 71 patients were included. Complete resolution was achieved in 33.8% of cases at 12 months, increasing to 57.7% at a median follow-up of 24 months. An additional 19.7% showed anatomical improvement. Mean CMT decreased significantly (from 639.5 μm to 316.7 μm at 12 months and 297.2 μm at final follow-up, P < .0001 for both), and median BCVA improved from 0.6 (20/80) to 0.3 (20/40) logarithm of the minimum angle of resolution (LogMAR) at both 12-month and final follow-up (P < .001). Anatomical and visual outcomes were comparable between primary and revisional surgeries. Multivariate analysis revealed that female sex (odds ratio [OR] = 5.7, P = .008) and presence of SRF only (OR = 8.0, P = .005) were independent predictors of complete resolution. Subretinal fluid-only configuration was also significantly associated with ≥0.2 LogMAR (2 Snellen lines) visual gain (OR = 5.0, P = .038). Intraoperative laser to optic disc edge was negatively associated with visual improvement (OR = 3.5, P = .048). Conclusions: Pars plana vitrectomy with ILM flap offers favorable long-term anatomical and functional outcomes for ODPM, thus representing an effective treatment, in particular in revision cases. The presence of isolated SRF appears to be a positive prognostic marker for both anatomical and visual recovery. In contrast, adjunctive laser photocoagulation may negatively impact visual recovery. Our findings support caution against unnecessary early reoperation. Financial disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.