Evaluating Dissociated Optic Nerve Fiber Layer Appearance Using En Face Layer Imaging Produced by Optical Coherence Tomography

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Abstract

Purpose: To investigate the incidence of and risk factors for a dissociated optic nerve fiber layer (DONFL) appearance after pars plana vitrectomy (PPV). Methods: We retrospectively reviewed 189 eyes that underwent PPV with internal limiting membrane removal and judged the presence/absence of an apparent DONFL based on en face layer images produced by spectral-domain optical coherence tomography (SD-OCT). Results: An apparent DONFL was observed in 47 (24.9%) eyes. The incidence of an apparent DONFL was significantly higher in the macular hole (MH) group (76.5%) than in the non-MH group (epiretinal membrane, diabetic macular edema, retinal vein occlusion, and others; 4.9%; p < 0.001). In the logistic regression analysis, surgical indication for MH was identified as the most significant DONFL risk factor (odds ratio 63.7; p = 1.05 × 10<sup>-8</sup>). Conclusion: Postoperative OCT en face layer imaging clarified that MH eyes are liable to have an apparent DONFL following PPV.

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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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Dissociated optic nerve fiber layer appearance after internal limiting membrane peeling for idiopathic macular holes.

Tomomi Yamakoshi, Hiroko Terasaki, Yasuki Ito … (2005)

To investigate the characteristics and incidence of a dissociated optic nerve fiber layer (DONFL) appearance in eyes after idiopathic macular hole surgery. Retrospective, nonrandomized, comparative interventional case series. Ninety-one eyes with idiopathic macular holes that were closed after 1 pars plana vitrectomy were studied. Among these, 67 eyes had the internal limiting membrane (ILM) peeled (ILM-peeled), and 24 did not have the ILM peeled (ILM-unpeeled). All patients received a complete ophthalmologic examination and color fundus photography preoperatively and postoperatively. Twenty ILM-peeled eyes and 9 ILM-unpeeled eyes were also examined by optical coherence tomography (OCT3), microperimetry by scanning laser ophthalmoscope (SLO), and macular sensitivity measurements by Humphrey visual field testing more than 4 months after the vitrectomy. Development of a DONFL on fundus photographs and OCT3, and the functional evaluation of a DONFL by best-corrected visual acuity, SLO-microperimetry, and Humphrey visual field testing. In 67 ILM-peeled eyes, a DONFL appearance was found in 36 eyes (54%) in color fundus photographs. A DONFL appearance was not detected in any of the 24 ILM-unpeeled eyes. Focal dehiscence of the optic nerve fiber layer was found in all 20 examined eyes by OCT3. No scotoma was found corresponding to the DONFL by SLO microperimetry. The best-corrected visual acuity and macular sensitivity were not significantly different in eyes with and without a DONFL appearance (P>0.05). A DONFL appearance was not detected in all 20 eyes examined within 1 month after surgery, was detected in all 16 eyes examined between 1 and 3 months, and no new cases were detected after 3 months. The DONFL appearance became more distinct until about 6 months after first detection and seemed not to change subsequently. The DONFL appearance in about half of the eyes with ILM peeling and none in eyes without ILM peeling strongly suggest that the DONFL appearance is related to ILM peeling. The OCT findings in eyes with no functional abnormality by SLO microperimetry suggested that the DONFL is due to a dehiscence of the optic nerve fiber layer and not a true nerve fiber layer defect.

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"Dissociated optic nerve fiber layer appearance" after internal limiting membrane removal is inner retinal dimpling.

Richard Spaide (2012)

To examine volume-rendered spectral-domain optical coherence tomography images in patients who had undergone vitrectomy, many of whom had internal limiting membrane removal to investigate a condition termed "dissociated optic nerve fiber layer appearance." Patients who had undergone vitrectomy for either macular hole or epiretinal membrane were evaluated. Spectral-domain optical coherence tomography B-scan images were acquired with the use of eye tracking at an interval of either 30 μm or 60 μm. These were registered and exported to a volume-rendering program, and the resultant volume-rendered images were evaluated. The images were graded for the presence of inner retinal abnormalities, and correlates were made to corresponding alterations seen in fundus photographs and B-scan spectral-domain optical coherence tomography images. There were 25 eyes of 24 patients with a mean age of 72.4 (± 7.3) years, 15 of whom were women. The primary preoperative diagnosis was macular hole in 10 eyes (40%) and epiretinal membrane in 15 eyes (60%). As part of the surgery, 18 eyes (72%) had planned peeling of the internal limiting membrane. Volume rendering showed that 13 eyes had pitting or dimples of the inner retinal surface that seemed to follow the course of the nerve fiber layer in the region of the macula. The inner retinal dimples occurred only in eyes that had internal limiting membrane peeling. Correlation of the volume-rendered images with B-scan spectral-domain optical coherence tomography showed focal areas of thinning of the ganglion cell layer with decreased reflectivity from the nerve fiber layer in the areas of the dimples. A high proportion of eyes with internal limiting membrane peeling develop inner retinal dimples that course along the path of the nerve fiber layer. The dimples seem to be the result of an interplay between trauma and healing processes constrained by nerve fiber layer and do not appear to be because of dissociation of optic nerve fibers. The true nature of the abnormalities induced should be investigated to evaluate the long-term risks and benefits of routine internal limiting membrane peeling.

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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: 2014

Publication date (Print): November 2014

Publication date (Electronic): 15 October 2014

Volume: 232

Issue: 3

Pages: 170-178

Affiliations

Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

Author notes

*Sentaro Kusuhara, MD, PhD, Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017 (Japan), E-Mail kusu@med.kobe-u.ac.jp

Article

Publisher ID: 364811 Other ID: Ophthalmologica 2014;232:170-178

DOI: 10.1159/000364811

PubMed ID: 25323920

SO-VID: b02ef026-55d3-4125-9cf3-bbd6dc57fc17

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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 : 29 November 2013

Date accepted : 22 May 2014

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Figures: 4, Tables: 2, Pages: 9

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Abstract

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Karger: Ophthalmology

Most cited references 22

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

Dissociated optic nerve fiber layer appearance after internal limiting membrane peeling for idiopathic macular holes.

"Dissociated optic nerve fiber layer appearance" after internal limiting membrane removal is inner retinal dimpling.

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