Surgical management of a case of double optic disc pits with maculopathy

Ramya R Nadig, Dhanashree Ratra
Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
Correspondence to: Dr. Dhanashree Ratra, Shri Bhagwan Mahavir Vitreoretina Services, Medical Research Foundation, Sankara Nethralaya, 18
College Road, Chennai ‑ 600 006, Tamil Nadu, India.
E‑mail: [e-mail]
Background: Double optic disc pit maculopathy is a rare entity. It can be difficult to manage because of excessive leakage and chronic
maculopathy. Purpose: To describe surgical management in a case of double optic disc pits with maculopathy. Synopsis: A 42‑year‑old
male presented with double optic disc pits with macular detachment in the left eye. The best‑corrected visual acuity (BCVA) was 20/60,
N12. Preoperative OCT showed the presence of two disc pits. The macular region had large retinoschisis and subretinal fluid (SRF)
with a central foveal thickness of 879 microns and loss of the ellipsoid zone. A shallow communication from the temporal aspect of the
disc to the submacular area was also noted. Among the options of observation, laser photocoagulation, and surgery, the patient opted
for surgical management. Surgical technique: A standard‑3 port 23‑gauge pars plana vitrectomy was done. After staining the ILM
with brilliant blue, ILM peeling was done with the help of forceps and Finesse loop. ILM flaps were inverted over to cover the optic
disc pits and sealed with a drop of fibrin glue. Next, 20% SF6 gas was used for tamponade. Pre‑ and post‑surgery parameters such as
visual acuity and OCT were evaluated. Postoperative evaluation: After 6 weeks, left eye BCVA was 20/40 with OCT showing reduced
SRF and reduced intraretinal schisis with a foveal thickness of 546 microns. At 3 months of follow‑up, the vision in the left eye had
improved to 20/30 with further reduction in the retinoschisis and foveal thickness of 482 microns. Highlights: In this interesting case,
we demonstrate a unique way of sealing the defect surgically by vitrectomy and inverted ILM flap with fibrin glue over the disc pits.
Despite sealing the maculopathy is slow to resolve.