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      Optic disc pit maculopathy: when and how to treat? A review of the pathogenesis and treatment options

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          Abstract

          Optic disc pit (ODP) is a rare congenital anomaly of the optic disc, which can be complicated by a maculopathy associated with progressive visual loss. Optic disc pits are usually unilateral and sporadic in occurrence, and the development of maculopathy is unpredictable with no known triggers. Optic disc pit maculopathy (ODP-M) is characterized by intraretinal and subretinal fluid at the macula, causing visual deterioration. The source of this fluid is still unclear, and several competing theories have suggested it may be vitreous fluid, cerebrospinal fluid, leakage from blood vessels at the base of the pit or leakage from the choroid. The mechanism of pathogenesis of ODP-M has not been fully elucidated, but vitreous liquefaction and traction and pressure gradients within the eye have been implicated to be involved. There are no clear guidelines on the management of patients with ODP-M, and numerous techniques have been described, including laser photocoagulation, intravitreal gas injection, macular buckling and pars plana vitrectomy with many different modifications. The majority of reports describe small series, and as there are no comparative studies there is no consensus regarding the optimal treatment for ODP-M. This review discusses the literature on the possible sources of fluid and mechanisms of pathogenesis in ODP-M, as well as the wide array of treatment modalities and their results. Based on these, a set of recommended key concepts for the timing and choice of treatment for these challenging are presented.

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          Optic disc pit: a review.

          Since Wiethe first described the clinical presentation of two optic disc depressions in a 62-year-old woman in 1882, there have been many studies addressing what later become known as the "optic disc pit." The main complication of this condition, termed optic disc pit maculopathy, is associated with visual deterioration. Treatment of optic disc pit maculopathy remains challenging. Here we review the body of literature that documents the clinical findings, pathophysiology, histology, main complications, treatment options, special features and presentations, and differential diagnosis of optic disc pit. The source of the intraretinal fluid in optic disc pit maculopathy remains controversial. Four possible sources of this fluid have been proposed: fluid from the vitreous cavity; cerebrospinal fluid originating from the subarachnoid space; fluid from leaky blood vessels at the base of the pit; and fluid from the orbital space surrounding the dura. Optic disc pits are a very rare clinical entity, affecting approximately one in 11,000 people. Patients with congenital optic disc pit sometimes remain asymptomatic, but 25% to 75% present with visual deterioration in their 30s or 40s after developing macular schisis and detachment. The most widely accepted treatment for such patients is a surgical approach involving pars plana vitrectomy with or without internal limiting membrane peeling, with or without endolaser photocoagulation and C3F8 endotamponade.
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            Pathogenesis and treatment of maculopathy associated with cavitary optic disc anomalies.

            To propose a unifying theory regarding the pathogenesis of maculopathy associated with cavitary optic disc anomalies and to describe a rational approach to achieving a permanent cure in affected eyes.
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              Vitrectomy without laser treatment or gas tamponade for macular detachment associated with an optic disc pit.

              To evaluate the clinical outcomes after vitrectomy, without gas tamponade or laser photocoagulation to the margin of the optic nerve, for the treatment of macular detachment associated with optic disc pits and to characterize retinal manifestations during treatment of optic pit maculopathy using optical coherence tomography (OCT).
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                Author and article information

                Contributors
                elad_moi@netvision.net.il
                jetmoiss@netvision.net.il
                anatl@tlvmc.gov.il
                Journal
                Int J Retina Vitreous
                Int J Retina Vitreous
                International Journal of Retina and Vitreous
                BioMed Central (London )
                2056-9920
                7 August 2015
                7 August 2015
                2015
                : 1
                : 13
                Affiliations
                [1 ]GRID grid.413449.f, ISNI 0000000105186922, Department of Ophthalmology, , Tel Aviv Sourasky Medical Center, ; 6 Weitzman st., Tel Aviv, 64239 Israel
                [2 ]GRID grid.12136.37, ISNI 0000000419370546, Affiliated to the Sackler Faculty of Medicine, , Tel Aviv University, ; Tel Aviv, Israel
                [3 ]GRID grid.413079.8, ISNI 0000000097528549, Department of Ophthalmology and Visual Science, , UC Davis Medical Center, ; Sacramento, CA USA
                [4 ]GRID grid.413795.d, ISNI 0000000121072845, Department of Ophthalmology, , Sheba Medical Center, ; Ramat Gan, Israel
                Article
                13
                10.1186/s40942-015-0013-8
                5088488
                27847606
                95261064-f83f-4580-94a1-907b9258c251
                © Moisseiev et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 June 2015
                : 30 July 2015
                Categories
                Review
                Custom metadata
                © The Author(s) 2015

                optic disc pit maculopathy,treatment,vitrectomy,review
                optic disc pit maculopathy, treatment, vitrectomy, review

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