視神経円板陥凹黄斑症：内境界膜フラップを伴う硝子体手術（OPTIMA試験報告1）の長期成績

To evaluate long-term anatomical and visual outcomes following pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) flap in the treatment of optic disc pit maculopathy (ODPM).

Multicenter, retrospective cohort study.

Patients with congenital ODPM who underwent primary or revisional PPV with ILM flap, with a minimum follow-up of 12 months.

Clinical data were retrospectively collected, including baseline characteristics, surgical details, fluid distribution, central macular thickness (CMT), and best-corrected visual acuity (BCVA) at baseline, and at 1, 6, and 12 months postoperatively, as well as at the final follow-up.

The primary outcome was the rate of anatomical resolution (defined as complete reabsorption of intra- and subretinal fluid) at 12 months. Secondary outcomes included anatomical resolution at last follow-up, change in central macular thickness (CMT) and BCVA, fluid distribution patterns, and identification of predictors of treatment response.

A total of 71 eyes from 71 patients were included. Complete resolution was achieved in 33.8% of cases at 12 months, increasing to 57.7% at a median follow-up of 24 months. An additional 19.7% showed anatomical improvement. Mean CMT decreased significantly (from 639.5 μm to 316.7 at 12 months and 297.2 μm at final follow-up, p<0.0001 for both), and median BCVA improved from 0.6 (20/80) to 0.3 (20/40) logMAR at both 12-month and final follow-up (p<0.001). Anatomical and visual outcomes were comparable between primary and revisional surgeries. Multivariate analysis revealed that female sex (OR=5.7, p=0.008) and presence of subretinal fluid (SRF) only (OR=8.0, p=0.005) were independent predictors of complete resolution. SRF-only configuration was also significantly associated with ≥0.2 logMAR (2 Snellen lines) visual gain (OR=5.0, p=0.038). Intraoperative laser to optic disc edge was negatively associated with visual improvement (OR=3.5, p=0.048).

PPV with ILM flap offers favorable long-term anatomical and functional outcomes for ODPM, thus representing an effective treatment, in particular in revision cases. The presence of isolated SRF appears to be a positive prognostic marker for both anatomical and visual recovery. In contrast, adjunctive laser photocoagulation may negatively impact visual recovery. Our findings support caution against unnecessary early reoperation.