Surgical intervention versus conservative management in optic disc pit maculopathy

To assess the functional and anatomical outcomes in patients with maculopathy related to an optic disc pit (ODP-M), managed with or without surgery.

This retrospective monocentric study, included 52 patients (52 eyes) with ODP-M. Of these, 52% (n=27) were managed conservatively, while 48% (n=25) underwent surgery. Primary outcomes included changes in best-corrected visual acuity (BCVA) and anatomical parameters [central macular thickness (CMT), sub-foveal choroidal thickness (SFCT)], as well as the rate of fluid resolution.

The mean age was 33.8±22.3y (range: 5–82y), with 27 females and 25 males. Median follow-up duration was 18.0mo [interquartile range (IQR) 7.0–41.5] for the non-surgical group and 15.0mo (IQR 9.0–48.0) for the surgical group. The surgical group demonstrated significantly greater BCVA improvement (mean change: -0.40±0.56 logMAR) compared with the non-surgical group (mean change: -0.03±0.19 logMAR; P=0.006). SFCT remained stable in the non-surgical group (mean change: +4.6±36.4 μm, P=0.74), and showed a greater decrease in the surgical group [mean change: -24.6 μm, 95% confidence interval (CI) -51.4 to +2.2 μm; P=0.06]. CMT decreased significantly in the surgical group (mean change: -392.2±287.9 μm, P<0.001), whereas it remained stable in the non-surgical group (mean change: -79.7±233.4 μm, P=0.09). Spontaneous subretinal fluid reduction was observed in 25.9% (n=7) of non-surgical eyes, compared with 72.0% (n=18) of surgical eyes (P<0.001), including complete fluid disappearance in 40.0% (n=10) of surgical cases.

Surgical intervention appears more effective than conservative management in achieving subretinal fluid reduction and BCVA improvement in eyes with ODP-M.