First, Do No Harm

Optic disc pits, rare congenital depressions or excavations of the optic nerve, are typically treated by surgery. The pits provide a passageway for vitreous humor to enter the subretinal space, causing retinal detachment and impacting patients’ vision. Because no medical therapies for optic disc pits exist, most surgeons perform a pars plana vitrectomy to allow the pits to close over, often combining the treatment with other procedures such as peeling of the inner limiting membrane (ILM) But is all this surgery really necessary? Researchers from the University of Alberta, Edmonton, Canada, say no.

“We went back and looked at the different surgeries that we can do to help solve this problem and what worked and what didn’t,” Jaspreet Rayat, an ophthalmology resident at Edmonton’s Royal Alexandra Hospital (1). “What we found is that a lot of surgical techniques that are commonly used are unnecessary and over the top. It’s like taking a baseball bat to a nail when a little hammer would do.” Rayat is lead author on the study, which involved examining the surgical outcomes of 32 eyes of 32 patients with optic disc pits and serous macular detachments (2). The authors concluded that, while early intervention with vitrectomy and posterior vitreal detachment maximizes surgical success (with a foveal reattachment rate of 81.3 percent and visual acuity improvements of approximately five lines), additional procedures such as gas tamponade, ILM peeling or temporal endolaser showed no benefit.

Not only do the additional procedures offer no added value, but they may in fact be harmful to patients’ vision. Rayat said, “Some of those procedures, such as doing laser surgery, can actually cause damage to the vision that will never be recovered. In the case of injecting gas in the eye, it can create bubbles that can remain in your eye for weeks, decreasing your vision and preventing you from enjoying your life. So using a cautious approach in these cases is prudent.” He and his colleagues suggest that, when addressing optic disc pits, it’s best to start in as conservative a manner as possible and only implement additional procedures if they are necessary. As Rayat says, “You don’t have to throw the entire kitchen sink at the problem.”