The method of surgical treatment of the optic nerve fossa

Objective. To demonstrate one of the methods of surgical treatment of the optic nerve pit using a clinical example. Methods. Patient P., 37 years old, came to the NMIC "MNTK "Microsurgery of the Eye" with complaints of a gradual decrease in vision in the right eye (OD). The following were performed: visometry, pneumotonometry, autorefractometry, perimetry, direct and indirect ophthalmoscopy, optical coherence tomography. Based on the results of examination and instrumental diagnostics, Vis OD is known to be 0.03 n / k (not corrected), intraocular pressure (IOP) OD = 18 mm Hg. Indirect ophthalmoscopy on OD visualizes an oval, pale depression, measuring 1/5 of the disc diameter (DD), located in the inferotemporal sector of the optic disc, the macular area is detached. Optical coherence tomography showed detachment of the neuroepithelium in the macula, epiretinal fibrosis. The diagnosis was: OD "Optic disc pit. Serous retinal detachment. Epiretinal fibrosis". Surgical treatment of OD was recommended to tamponade the optic disc pit and remove epiretinal fibrosis. During the operation, microinvasive subtotal vitrectomy was performed, the posterior hyaloid membrane was removed, the internal limiting membrane (ILM) with the subsequent use of an inverted ILM flap for tamponade of the optic disc pit, endolaser coagulation (ELC) of the temporal part of the optic disc. Parameters used in ELC: power 100 mW/cm2, wavelength 532 nm, pulse duration 100 ms. Air tamponade was performed intraoperatively. At the final stage, 0.05 ml of autologous platelet-rich plasma (PRP) is injected intravitreally over the optic disc pit using a 27G cannula. Results. Dynamically, a significant decrease in the height of neuroepithelial detachment, the height of retinoschisis in the upper parts of the macular zone, and neuroepithelial edema in the inner parts of the macular zone is noted. The optic disc pit is blocked. Vis OD = 0.25 n/c. IOP OD = 20 mm Hg. During dynamic observation after 5 months, the neuroepithelium is adjacent in all parts of the macular zone. Conclusions. This method ensures an increase in visual functions and anatomical closure of the optic disc pit due to the high content of growth and trophic factors in PRP; passive aspiration of excess PRP is performed under visual control, achieving its localization in the optic disc. ELC of the retina allows to form a chorioretinal adhesion, which prevents the flow of fluid from the subretinal space under the retinal neuroepithelium, interrupting the progression of detachment in the macular zone. Thus, this method is a combination of methods that allow to achieve anatomical closure of the optic disc pit and improve visual acuity in the postoperative period. Key words: optic disc pit, central retinal detachment, laser coagulation, platelet-rich plasma, congenital pathology