A recent study using spectral domain optical coherence tomography (SD-OCT) demonstrated that all eyes with ODP involved epipapillary membrane, which developed over time .
Taken together, previous findings suggest that traction force to the fragile optic disc of the posterior hyaloid membrane and/or epipapillary membrane is involved in the pathogenesis of maculopathy associated with congenital or acquired optic disc anomalies.
We retrospectively reviewed medical records of eight successive cavitary optic disc anomaly-associated maculopathy patients (eight eyes) that could be followed up for more than 6 months after PPV with epipapillary membrane removal.
Thereafter, the presence of the epipapillary membrane tissue was ascertained using triamcinolone acetonide and was carefully removed with the forceps under a high-magnification direct contact lens.
We defined the presence of epipapillary membrane, when all of the following 3 requirements were met: (1) the presence of hyperreflective lesion lying on the optic disc, on preoperative OCT; (2) a material attached on the disc that the operator could visually recognize and remove during surgery; and (3) optic disc cupping on postoperative OCT that became deeper than that on preoperative OCT.
An epipapillary membrane was observed at the cavitary sites of the disc in all eyes, regardless of the presence or absence of preoperative PVD (Figures 1(b), 2(b), 3(d), 5(b), and 6(c)).
In two ODP maculopathy patients (cases 1 and 2), even when PVD was artificially induced, the hyaloid membrane was attached on the epipapillary membrane, which was firmly fixed into the ODP (Figures 1(c)-1(e)).
OCT revealed that the excavation of the optic disc became deeper than that of pretreatment after the surgery with the removal of the epipapillary membrane in all patients (Figures 1(g), 2(c), 4(c), 5(e), and 6(d)).
In patients with maculopathy associated with congenital or acquired cavitary optic disc anomalies, we made the following observations: (1) an epipapillary membrane was observed in all patients via SD-OCT.
In all our patients without preoperative PVD, preoperative OCT revealed that the epipapillary membrane was present at the excavation sites of the disc, as shown in a recent study .
In this study, all patients with preoperative PVD had the epipapillary membrane on SD-OCT.
Furthermore, we detected GFAP and S100 proteins in the resected epipapillary membrane, suggesting the existence of astrocytes.