SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY IMAGING OF THE OPTIC PIT COMPLEX.

To assess vitreous findings in optic disc pit maculopathy using Optical Coherence Tomography (OCT). Thirty-eight eyes of 38 patients (14-51 years of age) with macular detachment associated with optic disc pit maculopathy were included in the study. The patients were divided into two groups. In group 1, 16 eyes were studied by OCT at presentation and after surgical treatment. In group 2, 22 eyes were examined by OCT only after treatment. In both groups thorough vitreous examination was performed over the macula and the optic disc. All patients were operated by the macular buckling procedure. Vitreous abnormalities were found in 28 out of 38 eyes (74%) of both groups. In group 1, 10 of the 16 eyes had vitreous traction on the macula at presentation. The traction started from the optic disc and terminated to the macula. The posterior hyaloid that exerted the traction between the points of adhesion at the optic disc and the macula had a course parallel to the retinal surface in 9 of the 10 cases. Postoperatively, vitreous traction on the macula was not found. Of the remaining 6 eyes 4 had complete or partial posterior vitreous detachment. In group 2, 8 eyes had vitreous strands over the optic disc and 5 eyes posterior vitreous detachment. In the remaining 9 cases no vitreous involvement was noticed. OCT was able to detect vitreous abnormalities such as vitreomacular traction, vitreous strands over the optic disc and complete or partial posterior vitreous detachment associated with optic disc pit maculopathy. Our observations support the view that the abnormal vitreous over the macula and optic disc is likely to play a role in the development of macular elevation in cases with optic disc pit. Prospective OCT studies could further assist to better understand the role of vitreous in this disease.

To construct swept source optical coherence tomography (SS-OCT) imaging system for root canal endoscopy, and to evaluate the accuracy of diagnosing artificial root fractures. An ultra-high-speed (40 kHz) swept laser source was developed based on the piezoelectric tuning filter and the Fourier domain mode locking (FDML) swept laser technology (patent number: 200620135940.2). Ultra-miniature gradient index lens technology (patent number: 201320241218.7) was used to create a thin endoscopic probe with a diameter of 0.86 mm for real-time image transmission. The SS-OCT light source had a wavelength of 1 310 nm and a bandwidth of 100 nm. The axial and transverse image resolutions were 15 μm and 25 μm, respectively. Artificial fractures were created on human mandibular premolars with single root and the premolar roots were prepared to 41 horizontal sections (1 mm thick). 27 root sections with fractures (width: 52-284 μm) and 14 the sections without fractures were observed under an optical stereomicroscope with a cold light source as the gold standard. The horizontal root sections were scanned by self-developed SS-OCT imaging system for root canal endoscopy with a central wavelength of 1 310 nm and bandwidth of 100 nm. The data were reconstructed with 30 μm thick slices at an interval of 30 μm. Two observers, a radiologist and an endodontist, were trained and independently evaluated all the reconstructed images blindly. The diagnostic performance of SS-OCT imaging system was calculated, and statistical analysis was performed. SS-OCT root canal endoscopic imaging system composed of high-speed swept laser source, fiber coupler, endoscopic probe, reference arm and differential detector. Root sections could be scanned by SS-OCT and imaged in realtime at a depth of 1 to 2 mm. The kappa value for interobserver agreement was 0.792, and the intraobserver agreement was 1.000 and 0.709 for two observers respectively. All of 27 fractured root sections and 12 of 14 root sections without fractures were accurately diagnosed while 2 unfractured root sections were misdiagnosed. The sensitivity was 1.000 and the specificity was 0.857 for diagnosis of artificial root fractures by SS-OCT. The positive predictive value (PPV), negative predictive value (NPV) and the overall accuracy rate were 0.931, 1.000 and 0.951 respectively. The swept source optical coherence tomography imaging system for root canal endoscopy is a promising imaging method for observing root fractures．.

PURPOSE:The purpose of this study was to analyze the diagnostic and therapeutic approach of five cases with optic disc pit (ODP) maculopathy.MATERIALS AND METHODS:This was a retrospective study of five patients diagnosed with ODP maculopathy. Four of these cases had unilateral involvement, whereas one case had bilateral findings. The medical notes of these individuals were reviewed in order to record the presenting symptoms, clinical signs, visual acuity (VA), imaging, management, and the final visual outcome on their last follow-up appointment.RESULTS:The first patient (53-year-old female) underwent a left pars plana vitrectomy (PPV) combined with inner retinal fenestration, endolaser, and perfluoropropane (C3F8) gas tamponade and her VA improved from 6/24 to 6/9 Snellen. A focal retinal laser treatment was carried out on our second patient leading to decrease of the subretinal fluid but had a poor visual outcome due to the underlying secondary glaucoma from iris melanoma treatment in the past. The third patient was an asymptomatic 7-year-old girl in which the maculopathy resolved spontaneously without any surgical intervention with a final VA of 6/5. The fourth and fifth patients were asymptomatic with good vision in both eyes and were, therefore, only monitored with follow-ups.CONCLUSION:ODP maculopathy remains a challenging clinical entity for a vitreoretinal surgeon. The current management for ODP maculopathy involves surgical procedures with PPV being a common treatment of choice. Spontaneous resolution of ODP maculopathy has also been reported. Our study highlights the contrasting management that can be adopted in the treatment of ODP maculopathy, and there is not one definite treatment for this condition.

Vitrectomy without Laser Treatment or Gas Tamponade for Macular Detachment Associated with an Optic Disc Pit

BackgroundCongenital optic disc pit (ODP) is a relatively uncommon congenital anomaly of the optic disc, which seriously affects the patient’s vision when combined with optic disc pit maculopathy(ODP-M). Currently, the treatment of ODP-M remains a clinical challenge and a focus of research.Case presentationA boy had a pit in the inferotemporal segment of the optic disc with ODP-M. Optical Coherence Tomography(OCT) showed ODP and serous retinal detachment. He was treated with pars plana vitrectomy(PPV), followed by Corneal Stromal Lenticule (CSL) sealing and C3F8 tamponade. In the end, significant anatomical improvement was achieved, and the Best Corrected Visual Acuity(BCVA) was improved.ConclusionsThe CSL transplantation may be a viable therapeutic option for improving ODP-M with stable anatomical and functional result. However, more cases and longer follow-up are needed to confirm the safety and effectiveness of the technology.

Purpose: To describe how Swept Source Optical Coherence Tomography (SS-OCT) provides enhanced diagnostic information enabling optimisation of surgical strategy in a pediatric patient suffering from ODP maculopathy. We report the first case of successful management of ODP maculopathy via pars plana vitrectomy (PPV) and air tamponade. Methods: Interventional case report. Results: A five-year-old girl presented with ODP and serous macular detachment in her previously amblyopic left eye. SS-OCT showed optically opaque vitreous fibres perpendicularly attached to the base of the optic nerve head excavation and what appeared to be fibrous tissue at the base of the excavation of the optic nerve head and attached to the pit. Detachment of the posterior hyaloid was induced during PPV, the pre-optic nerve head fibrosis was removed with forceps and fluid/air exchange was carried out to induce air tamponade. The serous macular detachment had resolved 11 months after the surgery and the optic pit was reduced in size. No maculopathy recurrences or complications such as cataract were observed. Best corrected visual acuity did not improve possibly because of pre-existing amblyopia. Conclusion: SS-OCT demonstrated anatomical features not previously described in ODP maculopathy and could assist in the choice of surgical technique. In patients with ODP maculopathy and documented optic nerve head vitreous attachment with peri-pit fibrosis, vitrectomy supplemented by tamponade with air alone may be a viable alternative to tamponade with gas with or without laser photocoagulation. This modified technique may reduce the risk of complications such as cataract formation.

ABSTRACT
 
 Introduction: Optic disc pit is a rare congenital abnormality of the optic disc. It is generally appears in the third or fourth decade of life; however, cases of serous detachment in children have been reported. Treatment includes argon laser to the peripapillary region, macular buckling surgery, vitrectomy combined with laser and/or gas injection.
 Objective: To report a case with optic disc pit maculopathy in a 13 years old child.
 Case Illustration: A 13 years old male presented to us with complaints of blurred vision in right eye started a month ago. No history of trauma. On examination, her visual acuities were 20/50 right and 20/20 left eye. Both anterior segments were normal, with normal intraocular pressures. OCT imaging showed optic disc pit located temporally, with associated serous macular detachment in the right eye.
 Result: After 12 weeks observation, there is no significant change in the examination of the visual acuity, fundus examination and OCT imaging.
 Conclusion: Currently there is no universally accepted treatment for optic disc pit maculopathy because the pathogenesis is not yet fully understood. In pediatric cases, 3-6 months of follow-up before any surgical and invasive procedures is appropriate.
 Keyword: Optic disc pit maculopathy, OCT imaging, observation.

Background: Optic disc pit (ODP) is a congenital anomaly characterized by indented area of the optic nerve head most likely originating from the incomplete closure of the superior edge of the embryonic fissure. Maculopathy can occasionally complicate this anomaly as intra-retinal and sub-retinal fluid at the macula. In result, maculopathy is associated with a poor visual prognosis due to a serous macular detachment, formation of macular hole, or atrophy of the retinal pigmented epithelium. In this case series, we report of three patients with unilateral ODP. Case report: We attempted to analyze the morphologic changes seen in the ODP and evaluate patients with a complete ophthalmologic evaluation, fundus color photography, spectral-domain optical coherence tomography (SD-OCT) scanning, and magnetic resonance imaging (MRI) of globe and orbit. Magnetic resonance imaging scan was done for optic disc diameter (ODD) and optic nerve sheath diameter (ONSD). Conclusion: We noticed that in the patient who presented with neurosensory detachment in the macula, the ONSD is larger than in the fellow eye and is larger than the remaining two patients with ODP and without neurosensory detachment of the retina.

We report a patient with recurrent optic disc pit (ODP) maculopathy after Valsalva's maneuver and discuss its pathophysiology. We also hypothesize the role of Valsalva's maneuver in its genesis. Case report of one patient, male, 12 years old. Serous retinal detachment may occur in association with the ODP, a developmental anomaly of the optic nerve head. Histopathologically, it consists of a dysplastic retina herniation into a pocket extending posteriorly through a defect in the lamina cribrosa into the subarachnoid space. These three different compartments-intraocular space, optic nerve head, and subarachnoid space-and the dynamic interactions among them should be understood as the key factors for the occurrence of ODP-related serous retinal detachment. Based on the possibility that serous retinal detachment secondary to the ODP could be related to the Valsalva's maneuver, we strongly recommend that patients with ODP be advised to avoid intense physical or work activities that may increase abdominal, thoracic, and cerebral pressure and to refrain from playing wind instruments to avoid pretreatment, per treatment, and post-treatment intercurrences.

Optic disk pit (ODP) is a rare congenital abnormality of the optic nerve head that can lead to a maculopathy characterized mainly by serous retinal detachment. Optic disk pit maculopathy (ODP-M) in children is rare, and at present, the best management is still unknown. Long-lasting ODP-M can lead to organic amblyopia and photoreceptor damage, whereas surgical treatments are invasive and have an uncertain prognosis. We present a case of spontaneous resolution of ODP-M in a child who was monitored morphologically and functionally during a 6-year follow-up. Between January 2010 and January 2016, we conducted follow-up examinations by fundus photography, optical coherence tomography, and microperimetry. At the first visit, a 12-year-old girl was asymptomatic with a visual acuity of 20/20 in both eyes. Optic disk pit maculopathy was observed, and the progression was monitored by follow-up optical coherence tomography. A progressive anatomical improvement with a spontaneous resolution of ODP-M occurred over a 2-year period. However, at the last follow-up visit, microperimetry showed a loss of threshold values of visual sensitivity. The combination of morphologic and functional evaluation over time can be useful to determine the best management of ODP-M, particularly in children for whom the conservative approach seems to be a valid alternative to surgery.

To report the results of vitrectomy with platelet-rich plasma (PRP) application and gas tamponade as a rescue therapy in previously vitrectomized eyes with optic disk pit (ODP) maculopathy. Three patients with visual loss due to persistent or recurrent ODP maculopathy who had undergone previous vitrectomy were offered application of PRP. Platelet-rich plasma was obtained by centrifugation of a blood sample from each patient. Surgery consisted of vitrectomy and internal limiting membrane peeling if the membrane had not been already removed (in two eyes). After fluid/air exchange, three drops of PRP were applied on the ODP followed by 8% C3F8 tamponade. Immediately after surgery, the patient remained supine for 30 minutes and then kept a face-down position for 2 weeks. Optic disk pit maculopathy improved as soon as two weeks after surgery and resolved in all eyes between six and eight months after PRP application. Patients were followed up for three years, with no recurrences. Visual acuity remained stable in one eye and improved in two eyes. Vitrectomy with PRP application may be useful as a rescue therapy in patients with refractory ODP maculopathy. Platelet-rich plasma may act by promoting the closure of the communication between the vitreous and the intraretinal/subretinal space at the pit. This treatment may avoid potentially harmful maneuvers that have been used to treat ODP maculopathy.

Background: Parkinson’s Disease (PD) is the second-most common neurodegenerative disease affecting the elderly population. The eye has been referred to as a window to the brain due to its inseparable relationship with the central nervous system. The development of Swept-Source Optical Coherence Tomography (SS-OCT) and Optical Coherence Tomography Angiography (OCTA) technologies has offered us a better imaging modality to study the impact of PD on the retina. Method: Seventy-five eyes of 42 early-stage PD patients and 150 eyes of 75 matched healthy controls were enrolled in the current study. We performed SS-OCT and SS-OCTA to assess retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) + inner plexiform layer (IPL), internal nuclear layer (INL) thickness, and retinal flow density and flow ratio. Results: Our study indicates decreasing superficial and deep flow density in most regions of the retina. Superficial and deep flow parameters were also associated with RNFL, GCL+IPL, and INL thickness. ROC analysis reveals superficial flow density demonstrated an Area Under Curve (AUC) of 0.688, which is greater than deep flow density and retinal thickness measurements. Conclusion: To the best of our knowledge, we are the first study using SS-OCT and SS-OCTA to study superficial and deep retinal flow changes in early-stage PD patients. Our study suggests decreasing retinal flow density provides greater diagnostic power than retinal thickness measurements in the early stage of PD. SS-OCTA parameters could potentially serve as imaging biomarkers in PD diagnosis and staging.

To report a cohort with optic disk pit maculopathy (ODPM) presenting with neurosensory macular detachment that were initially misdiagnosed and mistreated; and to describe structural features on spectral domain optical coherence tomography in misdiagnosed and all other consecutive cases of ODPM. Multicenter international retrospective cohort study. 59 eyes from 59 patients with ODPM. 1) Proportion of patients with ODPM initially misdiagnosed, inaccurate diagnosis and treatment. 2) Morphologic features on spectral domain optical coherence tomography: other causes of subretinal and/or intraretinal fluid, inner/outer retinoschisis, communication with optic disk pit, and retinal pigment epithelium alterations. 3) Visual and anatomical outcomes 6 months after proper treatment. Fifteen patients (25.4%) with ODPM were correctly diagnosed initially and those were significantly younger than misdiagnosed cases (age 33.8 ± 15.2 vs. 58.7 ± 15.8 years, P < 0.0001). Forty of forty-four misdiagnosed eyes (90.9%) were treated for their presumed diagnosis before referral. Eyes with initial misdiagnosis had significantly more outer retinoschisis at baseline (88.4 vs. 40.0%, P = 0.0002) and more retinal pigment epithelium alterations (90.0 vs. 27.3%, P < 0.0001) 6 months after proper treatment. Optic disk pit maculopathy is an underdiagnosed entity and can mimic other causes for subretinal fluid. Awareness and identification of pertinent spectral domain optical coherence tomography features can help avoid inappropriate and delayed treatment.

Purpose: To evaluate postoperative results of pars plana vitrectomy combined with an inverted internal limiting membrane-flap technique and intravitreal injection of viscoelastic material for optic disc pit maculopathy complicated by serous macular detachment in a child. Observations: Ocular examination included best-corrected visual acuity (BCVA) testing, slit-lamp biomicroscopy, dilated fundus examination, intraocular pressure measurement, optical coherence tomography (OCT) and color fundus photography. BCVA in the left eye was 20/50 (0.4). Preoperative OCT findings showed distortion of retinal layers, serous macular detachment and a large schisis cavity in the left eye. Foveolar depression was not determined due to the height of intraretinal fluid and subretinal fluid extending towards the optic disc pit. Retinal thickness in the macular area was 507 μm. Pars plana vitrectomy was performed in combination with an inverted internal limiting membrane internal limiting membrane-flap technique and intravitreal injection of viscoelastic material, followed by 15% C3F8 gas endotamponade. A follow-up OCT examination in 3 months showed decreased subretinal fluid, residual edema, and restored foveolar depression. Retinal thickness in the macular area was 328 μm. BCVA of the left eye improved to 20/32 (0.63). Conclusions: Pars plana vitrectomy with an inverted internal limiting membrane-flap technique for optic disc pit maculopathy allows to reduce an amount of intra- and subretinal fluid. A visco-associated flap fixation technique creates conditions for its stabilization, which ultimately contributes to improving anatomical and functional outcomes during surgery and in the postoperative period.

Optic disc pit (ODP) is a rare congenital defect presumably arising from the failure of fetal fissure closure in embryogenesis. It occurs in about 1 in 10,000 people with no gender predilection. ODP is usually unilateral. We describe the case of a 52-year-old female patient who presented for a regular ophthalmic examination. Visual acuity was 20/20 and anterior segment was unremarkable in both eyes. Fundus revealed a bilateral optic pit located inferotemporally within the nerve (A,B). Swept-Source Optical Coherence Tomography demonstrated the defect caused by the ODP without secondary retinoschisis or subretinal fluid in both eyes (C,D). Optical Coherence Tomography Angiography (OCT-A) showed the ODP as a hyporeflective lesion in the optic nerve head, irregular-shaped in the right eye and round-shaped in the left eye (E,F). OCT-A has also displayed a decrease in vascular density with no-flow within the defect (G,H). A 6-month clinical monitoring has been undertaken.