Fovea-Sparing Internal Limiting Membrane (ILM) Peeling and ILM Plug: A Novel Approach for Managing Optic Disc Pit Maculopathy

Purpose: To evaluate the efficacy of fovea-sparing internal limiting membrane (ILM) peeling combined with ILM plug placement in patients with optic disc pit maculopathy (ODP-M). Patients and Methods: This retrospective study included seven eyes from seven patients diagnosed with ODP-M, treated with fovea-sparing ILM peeling and ILM plug placement. All patients underwent pars plana vitrectomy (PPV), with either SF6 gas or silicone oil used as tamponade. Outcome measures included best-corrected visual acuity (BCVA), central macular thickness (CMT), retinal reattachment, and resolution of retinoschitic lesions (RL). Data were collected at baseline and during follow-ups at 1, 3, 6, and 12 months. Results: The mean age of the study patients was 31 (f 13.14) years, with a marginal male preponderance (M: F = 4:3). All patients achieved complete retinal reattachment, with a significant reduction in CMT from 503.57 (f 154.74) mu m preoperatively to 286.29 (f 22.43) mu m at 12 months (P=0.02). BCVA improved in 85.7% of patients, from a mean of 0.77 (f 0.19) logMAR to 0.5 (f 0.25) logMAR by 12 months, though this was not statistically significant (P=0.27). Complete resolution of RL was observed in 71.4% of eyes, while 2 eyes showed partial resolution. One patient developed retinal detachment postoperatively, which was successfully managed with additional surgery. Conclusion: Fovea-sparing ILM peeling combined with ILM plug placement resulted in favorable anatomical and functional outcomes for ODP-M patients, with a 100% retinal reattachment rate and significant CMT reduction. This technique offers a viable alternative to conventional approaches, preserving foveal architecture while providing a mechanical barrier to fluid accumulation.