What is your surgical approach for optic disc pit retinal detachments if laser treatment is unsuccessful?

Vitrectomy with ILM peeling, creation of a pedunculated ILM flap that I attempt to insert into the pit to serve as a plug, peripapillary laser barricade, gas tamponade, and face-down positioning. If that fails, I will also consider using tissue glue to try to plug the pit further along with repeatin...

Topical dorzolamide is worth trying before surgical intervention.

If a pedunculated ILM flap is unsuccessful in surgery, an amniotic membrane graft to cover the ON pit is another option.