Anatomical and functional outcome of surgical correction of optic disc pit maculopathy using autologous scleral patch graft: a long-term retrospective analysis.

Abstract

Background: Optic disc pit (ODP) is a rare congenital anomaly of optic nerve head and is associated with maculopathy. Scleral patch graft (SPG) as a therapeutic option is recently advocated.

Methods: This is a retrospective analysis of 54 patients with ODP maculopathy who were followed up for 12 months post-operatively. The parameters assessed included best corrected visual acuity (BCVA) in LogMAR chart and central macular thickness (CMT) at baseline and at 1-, 3- and 12-months post-surgery.

Results: The mean age of presentation was 36.36 ± 15.69 years [Median 36, Interquartile range (IQR) 14.75]. 51.85% were female. 53.7% were operated in left eye. The average period of follow-up was 15.37 ± 2.34 months after surgery. The mean presenting BCVA in LogMAR chart was 0.66 ± 0.37 (Median 0.6, IQR 0.4) and average CMT was 677.46 ± 251.57µ (Median 674, IQR 276). On follow up over 1, 3 and 12 months, average BCVA were 0.74, 0.58 and 0.49 LogMAR respectively. The improvement in final BCVA was statistically significant (p = 0.016). The CMT at the corresponding follow-up periods were 461.26 ± 238.3µ (Median 435, IQR 220.5), 362.68 ± 125µ (Median 367, IQR 141) and 287.36 ± 121.9µ (Median 266, IQR 139.5). Decrease in CMT was significant at all follow up visits (p < 0.001). On assessing OCT Biomarkers, Subretinal fluid (57.4%), Intraretinal Fluid (57.4%), macular schitic cavity (79.63%), Outer Lamellar Macular hole (31.48%), Pachychoroid vessels (35.19%), Outer Retinal Layer Disruptions (24.07%) were present in various proportions on presentation. After surgery over the follow-up, retinal fluid and schitic cavities were observed to get regressed over time. Outer Lamellar Macular holes showed excellent regression after surgery over a period of time. On final visit after 1 year of surgery, complete anatomical success in terms of OCT interpretation was achieved in 16 cases (29.63%). Partial anatomical success was achieved in further 24 cases (44.44%). At least some anatomical improvement was seen in 49 patients while in 3 patients it remained almost unaltered and 2 cases worsened. Successful visual rehabilitation was achieved in 45 patients (83.33%) CONCLUSIONS: Detailed OCT based and functional analysis in this study with long-term follow-up helps to entitle the importance of scleral patch graft based surgical procedure in managing this challenging surgical condition. This article caters the largest case series with meticulous analyses of the ODP Maculopathy surgically managed using autologous scleral plug.