Surgical Options and Outcomes in the Treatment of Optic Pit Maculopathy: A Meta-analysis and Systematic Review

Purpose: Optic pit maculopathy (OPM) is an uncommon cause of vision loss with no standard surgical treatment. Surgical treatment involves pars plana vitrectomy (PPV), often combined with adjunctive procedures. Large studies comparing outcomes of these approaches are lacking because of low disease incidence. Therefore, we conducted a meta-analysis of PPV without or with adjunctive procedures.

Design: Meta-analysis and systematic literature review.

Methods: We conducted a literature search to identify clinical studies and case series of surgically managed OPM. Inclusion criteria were: (1) more than 2 patients, (2) treatment with PPV, and (3) reporting of preoperative and postoperative visual acuity data. We excluded review articles and studies not available in English. Results were analyzed using a 1-way analysis of variance, Pearson's chi-square test, and simple linear regression. Publication bias was modeled using funnel plots.

Main outcome measures: Visual acuity changes, resolution rate, resolution time, and change in OCT thickness.

Results: We identified 26 studies, encompassing 27 years and 342 patients. We identified 6 commonly reported techniques: PPV alone (92 patients), PPV plus juxtapapillary laser treatment (JPL; 146 patients), PPV plus internal limiting membrane peeling (ILMP; 50 patients), PPV plus both ILMP and JPL (16 patients), PPV plus inner retinal fenestration (18 patients), and PPV plus autologous platelet concentrate (22 patients). All groups demonstrated improved best-corrected visual acuity (BCVA; average, 0.46 logarithm of the minimum angle of resolution [logMAR]; 95% confidence interval [CI], 0.41-0.51 logMAR) compared with baseline, with no differences between groups (P = 0.11). The average OPM resolution rate was 70% among all groups (range, 56%-100%), and the average time to resolution was 8.4 months for all groups (95% CI, 7.2-9.6 months). Central macular thickness was reduced in all groups with no differences between groups (P = 0.15). Tamponade had no effect on outcomes. Linear regression analysis demonstrated significant correlations between preoperative BCVA and above outcome measures. Funnel plots demonstrated positive publication bias in PPV and PPV plus JPL groups.

Conclusions: We did not identify any significant differences in outcomes among 6 different surgical techniques. This study is limited by its inclusion of primarily retrospective studies and positive publication bias.