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Hyung-Woo Kwak, Kook Young Kim, TaeGi Kim, Kyung Hoon Seo, Seung-Young Yu; Morphological Change of Inner Retinal Layer on Spectral Domain Optical Coherence Tomography following Macular Hole Surgery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3340.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the morphological changes of the inner retinal layer by spectral-domain optical coherence tomography (SD-OCT) after idiopathic full thickness macular hole surgery.
This retrospective study examined 52 eyes of 49 patients with macular holes closed surgically following vitrectomy. All patients were followed postoperatively for more than 6 months. Cross-sectional and retinal surface images were obtained using SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, CA) before and after surgery. In 40 of the 52 eyes, macular ganglion cell-inner plexiform layer (GCIPL) thickness was assessed by SD-OCT. In 24 of the 52 eyes, fundus autofluorescence (FAF) was analyzed.
The incidence of dissociated optic nerve fiber layer (DONFL) increased gradually over time after surgery: 22 eyes (42.3%, 1 month), 41 eyes (78.8%, 3 months), and 46 eyes (88.5%, 6 months) by cross-sectional imaging; 23 eyes (44.2%, 1 month), 39 eyes (75.0%, 3 months), and 43 eyes (82.7%, 6 months) by retinal surface imaging; and 15 eyes (28.8%, 1 month), 33 eyes (63.5%, 3 months), and 36 eyes (69.2%, 6 months) by color fundus photography. 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. The GCIPL thickness of all subfields were significantly decreased (p<0.05), and the temporal GCIPL thickness decreased more than nasal GCIPL (p<0.001). Postoperative BCVA 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.
The incidence of DONFL increased to 80% at 6 months after surgery. The healing process after vitrectomy for MH is not limited to the RNFL affecting deeper structural changes. Further investigations are required to evaluate the pathophysiologic mechanism of inner retinal change after MH surgery.
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