Formation of an Intraretinal Fluid Barrier in Cavitary Optic Disc Maculopathy

Cavitary optic disc maculopathy develops when fluctuating pressure gradients along anomalous communications in the optic nerve head induce migration of fluid into the adjacent retinal tissue. We sought to determine whether carefully titrated laser photocoagulation combined with vitrectomy and gas tamponade can safely create an effective intraretinal barrier to fluid egress from the optic disc cavitation.

Retrospective interventional case series.

We retrospectively evaluated medical records and imaging studies of 22 consecutive patients with cavitary disc maculopathy evaluated by a single surgeon between 1991 and 2014. Patients requiring surgery underwent carefully titrated juxtapapillary laser photocoagulation followed immediately by vitrectomy and gas tamponade. Main outcome measures were change in visual acuity, macular fluid resolution, and recurrence of maculopathy.

Eleven patients (11 eyes) had undergone vitreous surgery and were included in the study. No preoperative evidence for vitreous traction on the optic disc or macula was seen in any eye. Nine patients underwent a single surgery and 2 patients required additional procedures to resolve the macular fluid. Mean length of follow-up after the last surgery was 48.2 months (range, 4-143 months). All 11 patients (100%) had complete resolution of macular fluid, with an average time to resolution of 8.5 months (range, 1-18 months). Only 1 of 11 patients (9%) had recurrence of macular fluid (14 months postoperatively). The average preoperative visual acuity of 20/125 (logMAR 0.81, standard deviation [SD] = 0.36) improved by nearly 4 lines to an average final visual acuity of 20/57 (logMAR 0.45, SD = 0.37) (P = .0072). A possible laser-induced central scotoma was suspected in only 1 patient who had undergone extensive prior laser treatments.

An effective intraretinal barrier to fluid migration from cavitary optic disc anomalies can be safely achieved in most patients with carefully titrated juxtapapillary laser photocoagulation combined with vitrectomy and gas tamponade. Once achieved, the barrier facilitates resolution of macular fluid and long-term avoidance of recurrent maculopathy.