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Franck Amouyal, Carolyn Pan, Steven Schwartz, Jean-Pierre Hubschman; Inner Retinal Dimples Occur Following Inner Limiting Membrane Peeling Without Staining. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3334.
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© ARVO (1962-2015); The Authors (2016-present)
To report and analyze the appearance and evolution of inner retinal defects, often referred to as dimples, after inner limiting membrane (ILM) peeling for full thickness macular hole (FTMH) with spectral-domain optical coherence tomography (SD-OCT).
Retrospective observational case series. Patients with the diagnosis of FTMH, who underwent 23-gauge pars plana vitrectomy with ILM peeling without adjunctive ILM staining were included. All surgeries were performed by a single surgeon (J-PH). The inner retina was evaluated pre-operatively and post-operatively with both standard SD-OCT and en face OCT. Inner retinal defects were detected, measured and analyzed 1, 3, 6 and 12 months after surgery. Snellen visual acuity (VA) was also assessed for functional evaluation pre-operatively and post-operatively.
A total of 50 patients were identified. No inner retinal dimples were observed preoperatively. Of the 50 patients, inner retinal dimples involving the nerve fiber layer (NFL) were observed in 39 patients (78%) in the first post-operative month. These appear to enlarge with time. Average pre-operative and post-operative VA were 20/125 and 20/50, respectively; no difference were found between patients with dimples and patients without dimples.
Inner retinal dimples are commonly observed following ILM peeling, emerging weeks after the surgery. These lesions appear to evolve in the post-operative period. No staining agents were used in this study, which negates the prior hypothesis that these defects were consequences of dyes commonly used in membrane peeling. Other hypotheses include injury to or loss of Müller cells that are necessary to maintain adhesion of NFL bundles or trauma incurred with the « pinch » to initiate peeling. The etiology of these dimples is still unclear and further studies with more patients and longer follow-up are indicated.
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