Surgical and Observational Outcomes in Optic Pit Maculopathy: A Comparative Analysis of Pediatric and Adult Populations

Summary

Surgical management of OPM achieves similar good anatomic and VA results in pediatric and adult populations. Retrospective, 58 eyes.

Abstract

Purpose: To evaluate anatomical and functional outcomes of surgical and observational management in patients with optic pit maculopathy (OPM), comparing pediatric and adult populations, and to explore the association between baseline OCT characteristics and clinical outcomes.

Design: Retrospective observational cohort study.

Participants: Patients diagnosed with OPM and followed at the Rothschild Foundation Hospital between January 2010 and July 2024.

Methods: This retrospective study included patients with clinically or imaging-confirmed OPM and a minimum of 6 months of follow-up. Eyes were categorized into surgical or observational groups based on individualized clinical management. Structural OCT was used to evaluate quantitative and qualitative features at baseline and final follow-up. Primary outcomes included anatomical success, defined as resolution of maculopathy on OCT, and functional improvement, defined as change in best-corrected visual acuity (BCVA). Secondary outcomes included time to resolution, retreatment rates, complication rates, and the association between baseline OCT features and clinical outcomes.

Main outcome measures: Anatomical success, BCVA at last follow-up, association between OCT features and surgical or visual outcomes.

Results: Out of 58 eyes with optic disc pit (ODP), 43 (74.1%) presented with OPM. Thirty eyes underwent surgery, achieving anatomical surgical success in 20 eyes (66.7%). Surgically managed eyes showed significant improvements in BCVA (0.92 ± 0.62 to 0.44 ± 0.39 logarithm of the minimum angle of resolution, P < 0.001) and central macular thickness (710 ± 248 μm to 321 ± 168 μm, P < 0.001). Pediatric patients were more likely to undergo surgery than adults (82.6% vs. 55.0%, P = 0.049) and exhibited larger ODP opening area (P = 0.02). A significant inverse correlation was observed between pit size and age among eyes with OPM (P = 0.003). Despite these differences, we did not detect statistically significant differences in outcomes between pediatric and adult groups. No baseline OCT features significantly predicted final visual or anatomical success.

Conclusions: Surgical management of OPM achieves meaningful anatomical and visual improvements in both pediatric and adult patients. Pediatric patients showed similar outcomes than adults. Although OCT biomarkers provide valuable structural information, their standalone prognostic value seems limited. These findings support surgical intervention, particularly in pediatric cases at risk for long-term visual impairment.