Optic pit: to operate or to observe?

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.

Keywords

optic pit / retinal neuroepithelial detachment / vitrectomy / pediatric ophthalmology

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