Morphological Change of Inner Retinal Layer on Spectral-Domain Optical Coherence Tomography following Macular Hole Surgery

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Abstract

Background/Aims: To investigate the morphological changes of the inner retinal layer by spectral-domain optical coherence tomography (OCT) after idiopathic full-thickness macular hole (MH) surgery. Methods: In a retrospective study, the authors evaluated 52 eyes of 49 patients with MH closed following vitrectomy. All patients were followed postoperatively for more than 6 months. Cross-sectional and retinal surface images were obtained using Cirrus high-definition OCT before and after surgery. In 24 of the 52 eyes, fundus autofluorescence (FAF) was analyzed. Results: The incidence of dissociated optic nerve fiber layer (DONFL) increased gradually over time after surgery. 57.7% had defects of only the retinal nerve fiber layer (RNFL) and 30.8% had defects in the inner plexiform layer at 6 months after surgery. Postoperative best-corrected visual acuity did not differ significantly based on the depth of the DONFL (p = 0.299). There were no changes in FAF in the area with DONFL. Conclusions: DONFL is characterized by progressive defects that are not limited to RNFL thickness. The healing process after vitrectomy for MH is not limited in the RNFL affecting deeper structural changes. Further investigations are required to evaluate the pathophysiological mechanism of inner retinal change after MH surgery.

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Most cited references 26

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Macular hole surgery with and without internal limiting membrane peeling.

H.Logan Brooks (2000)

To compare results of surgery for idiopathic macular hole with and without internal limiting membrane (ILM) peeling in a series of consecutive patients over a 5-year period. A retrospective, nonrandomized, comparative trial with concurrent control group. Forty-four eyes with macular holes of less than or equal to 6 months duration without ILM peeling were compared to 116 eyes with ILM peeling and the same hole duration. A third group of 65 eyes with ILM peeling and duration greater than 6 months was also evaluated. All eyes underwent pars plana vitrectomy with or without ILM peeling, intravitreous gas, and positioning face down. No adjunctive therapies were used in any group. Comparing the closure and/or reopening rate, prognosis, visual acuity, and complications for macular holes with and without ILM peeling. All patients had postsurgical follow-up of 18 months or greater. Primary closure was significantly improved with ILM peeling with 116 of 116 eyes (100%) showing no reopenings versus 36 of 44 holes (82%) primarily closed, 9 of which (25%) reopened without ILM peeling (P: < 0.00001) in holes less than or equal to 6 months. The 27 eyes without ILM peeling that had successful surgery displayed a mean postoperative vision of 20/40, which is the same as the successful eyes with ILM peeling (P: = 0.6). The 52 stage II eyes with ILM peeling had a mean postoperative vision of 20/30, and 48 of the 52 eyes (92%) were 20/40 or better. Stage III eyes (greater than 400-microm holes) without ILM peeling had a poor prognosis, with 6 of the 25 eyes (24%) having initial surgery fail and an additional 4 of 25 eyes (16%) reopening. Without ILM peeling, holes less than 300 microm had only one reopen, whereas holes greater than or equal to 300 microm had 16 of the 17 (94%) primary failures and/or reopenings (P: < 0.001). All 12 holes that reopened and/or primarily failed were repaired with ILM peeling with excellent visual recovery. Macular holes with a duration greater than 6 months were treated with ILM peeling, and 63 of 65 holes (97%) were closed primarily and 65% had an increase in vision by two or more Snellen lines. ILM peeling significantly improves visual and anatomic success in all stages of recent and chronic macular holes and reopened and failed holes, while eliminating reopening for holes greater than 300 microm.

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Vitreous Surgery for Idiopathic Macular Holes

Neil E. Kelly (1991)

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Dissociated optic nerve fiber layer appearance of the fundus after idiopathic epiretinal membrane removal.

R Tadayoni, P Massin, A Gaudric … (2001)

To report the appearance of the fundus, that is seen frequently after removal of an idiopathic epiretinal membrane and which we refer to as the dissociated optic nerve fiber layer appearance. Interventional, noncomparative retrospective case series. One hundred consecutive patients with an epiretinal membrane who underwent pars plana vitrectomy and epiretinal membrane peeling in one eye. Only patients with an idiopathic epiretinal membrane or a membrane associated with a peripheral retinal tear, but without retinal detachment, were considered for this study. Sixty-one patients met these criteria for one eye. Preoperative and postoperative best-corrected visual acuity and preoperative and postoperative blue filter fundus photographs were reviewed. Histopathologic specimens of epiretinal membranes were available for 14 eyes. The postoperative incidence of the dissociated optic nerve fiber layer appearance on blue filter photographs, visual acuity changes, and the presence of internal limiting membrane in epiretinal membrane specimens. The postoperative incidence of this feature on blue filter fundus photographs was 43%. No difference was found between eyes with or without this feature concerning the average preoperative and postoperative best-corrected visual acuity or the average change in visual acuity. Internal limiting membrane was present in all 14 epiretinal membrane specimens available. Five of these 14 patients concerned exhibited a dissociated optic nerve fiber layer appearance and 9 did not. The dissociated optic nerve fiber layer appearance occurred frequently after removal of an epiretinal membrane. As far as we know, this feature has not been previously reported. It consisted of numerous arcuate striae within the posterior pole in the direction of the optic nerve fibers and slightly darker than the surrounding retina. This feature had no functional effect noticeable by the patient and did not preclude good visual recovery. The small number of histologic samples and the impossibility of quantifying the area of internal limiting membrane peeled off did not allow us to supply proof that this feature is due to the extensive peeling of the internal limiting membrane, although this is the most likely hypothesis.

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Author and article information

Journal

Journal ID (publisher-id): OPH

Journal ID (nlm-ta): Ophthalmologica

Journal ID (doi): 10.1159/issn.0030-3755

Title: Ophthalmologica

Publisher: S. Karger AG

ISSN (Print): 0030-3755

ISSN (Electronic): 1423-0267

Publication date Subscription-year: 2013

Publication date (Print): June 2013

Publication date (Electronic): 07 May 2013

Volume: 230

Issue: 1

Pages: 18-26

Affiliations

^aDepartment of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, ^bDepartment of Ophthalmology, School of Medicine, Kangwon National University, Chuncheon, and ^cDepartment of Ophthalmology, Eulji University Hospital, Eulji University, Daejeon, Republic of Korea

Author notes

*Hyung Woo Kwak, Department of Ophthalmology, Kyung Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul (Republic of Korea), E-Mail hwkwak@khu.ac.kr

Article

Publisher ID: 350552 Other ID: Ophthalmologica 2013;230:18-26

DOI: 10.1159/000350552

PubMed ID: 23652718

SO-VID: 077fe3b7-d6a7-4064-9216-57f3fdfc9b4d

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 17 December 2012

Date accepted : 05 March 2013

Page count

Figures: 4, Tables: 1, Pages: 9

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Morphological Change of Inner Retinal Layer on Spectral-Domain Optical Coherence Tomography following Macular Hole Surgery

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Abstract

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Karger: Ophthalmology

Most cited references 26

Macular hole surgery with and without internal limiting membrane peeling.

Vitreous Surgery for Idiopathic Macular Holes

Dissociated optic nerve fiber layer appearance of the fundus after idiopathic epiretinal membrane removal.

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