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The relationship between a dissociated optic nerve fibre layer appearance after macular hole surgery and M uller cell debris on peeled internal limiting membrane
Author(s) -
Steel David H. W.,
Dinah Christiana,
White Kathryn,
Avery Peter J.
Publication year - 2017
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.13195
Subject(s) - retinal , internal limiting membrane , ophthalmology , medicine , vitrectomy , optical coherence tomography , visual acuity , optic nerve , nerve fibre layer , macular hole , inner limiting membrane
Purpose A dissociated optic nerve fibre layer ( DONFL ) is a characteristic change noted in inner retinal morphology after internal limiting membrane ( ILM ) peeling. It is thought to be due to trauma to Muller cells as the ILM is peeled from their attached end plates. In this study, we aimed to determine the extent and size of Muller cell debris on the retinal side of excised ILM and assess whether this correlated with the extent of DONFL observed postoperatively. Method Prospective single centre study of a consecutive series of patients undergoing macular hole surgery. Transmission electron microscopy of the ILM was used to assess Muller cell debris and postoperative spectral domain optical coherence tomography ( SD‐OCT ) to assess the extent of DONFL . A variety of other pre‐ and postoperative features was also included. Results Thirty‐nine patients were analysed. There were retinal dimples characteristic of DONFL detected on SD ‐ OCT in all 39 eyes. The portion of the retinal side of the ILM specimen covered by cellular debris ranged from 12% to 49%, with a median of 28%. Using linear regression, the percentage of retinal debris, the size of the debris and the postoperative visual acuity were significantly positively associated with the DONFL score. The total R squared for the model was 63.9%. Conclusion The extent of DONFL observed postoperatively can be partly explained by the amount of retinal side cellular debris on the retinal side of the peeled ILM . Surgical strategies which minimize this material could reduce the extent of DONFL .