Optic pit: to operate or to observe?

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Abstract

AIM: To evaluate the dynamics of maximally corrected visual acuity and retinoschisis height in children with congenital optic pit during dynamic observation and determine the terms and indications for surgical treatment.

MATERIAL AND METHODS: During the examination and follow-up of 22 patients (23 eyes), two groups were identified. Group 1 included 11 patients (11 eyes) who underwent surgical treatment because of the negative dynamics of BCVA (more than 0.1 in 6 months) and an increase in the formation of neuroepithelial detachment (NED) found in optical coherence tomography (OCT). Group 2 consisted of 11 patients (12 eyes) who had no significant deterioration in BCVA and had a stable OCT pattern for 6 months. The patients from group 2 were only under dynamic supervision. The dynamics of BCVA after surgery in the presence of indications and the stability of BCVA in the case of dynamic observation in the absence of negative dynamics were compared.

RESULTS: In the absence of a decrease in BCVA by more than 0.1 and without progression of neuroepithelial detachment, according to OCT data, only dynamic monitoring is required. Surgical treatment of complications with fovea should be performed according to indications. The treatment leads to gradual (up to 15–18 months) regression of retinoschisis and detachment of the retinal neuroepithelium and increases and stabilizes the BCVA.

CONCLUSION: If there are signs of progression of the process (decreased visual acuity, increased height and extent of detachment, edema, and separation of the retinal neuroepithelium), the patient should be referred to a vitreoretinal surgeon for surgical treatment 6 months after the initial examination, with a decrease in the maximum corrected visual acuity by more than 0.1 with concomitant negative dynamics according to optical coherent tomography in the form of increased detachment of the neuroepithelium.

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About the authors

Jeanne L. Alexandrova

The S. Fyodorov Eye Microsurgery Federal State Institution, Saint-Petersburg branch

Email: Jannalvovna@mail.ru
ORCID iD: 0000-0001-9743-4232

MD, Cand. Sci. (Medicine)

Russian Federation, Saint-Petersburg

Yaroslav V. Bayborodov

The S. Fyodorov Eye Microsurgery Federal State Institution, Saint-Petersburg branch; North-Western State Medical University named after I.I. Mechnikov

Email: yaroslavvitsug@rambler.ru
ORCID iD: 0000-0001-9193-6522
SPIN-code: 2702-4365

MD, Cand. Sci. (Medicine)

Russian Federation, Saint-Petersburg; Saint-Petersburg

Kristina K. Schefer

The S. Fyodorov Eye Microsurgery Federal State Institution, Saint-Petersburg branch; North-Western State Medical University named after I.I. Mechnikov

Email: kristinashefer@yahoo.com
ORCID iD: 0000-0003-0568-6593
SPIN-code: 2260-1969

MD, Cand. Sci. (Medicine)

Russian Federation, Saint-Petersburg; Saint-Petersburg

Alexander I. Shilov

The S. Fyodorov Eye Microsurgery Federal State Institution, Saint-Petersburg branch

Author for correspondence.
Email: alshilov1995@mail.ru
ORCID iD: 0000-0003-3315-3057

MD, ophthalmologist 

Russian Federation, Saint-Petersburg

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2. Fig. 1. Membranous valve of the optic disc pit.

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3. Fig. 2. Connection of the optic pit and subretinal space through the membranous valve of the optic disc.

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4. Fig. 3. Dynamics of best corrected visual acuity in patients in group II against the background of dynamic observation.

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5. Fig. 4. Patient N, 11 years old. Diagnosis: complicated optic pit, stage IV. Optical coherence tomography shows detachment of the neuroepithelium in the macular zone, retinoschisis spreading from the optic disc to the macular zone, and local destruction of the pigment epithelium in the macula.

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6. Fig. 5. Clinical case: patient N, 6 years old. Diagnosis — optic pit complicated by retinoschisis: a — high retinoschisis was detected on initial examination, up to 1000 microns, VisOS=0.1; b — height of retinoschisis a month after surgery: microinvasive vitrectomy with removal of the posterior hyaloid membrane and peeling of the inner boundary membrane, VisOS=0.3; c — almost complete regression of retinoschisis, 15 months after surgery, VisOS=0.4.

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7. Fig. 6. Dynamics of the height of neuroepithelial detachment and retinoschisis in treated patients.

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8. Fig. 7. Dynamics of best corrected visual acuity in operated patients before and 6 months after surgery.

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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