September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Factors Associated with Development of Dissociated Optic Nerve Fiber Layer (DONFL) Appearance in the PIONEER Study
Author Affiliations & Notes
  • Anne Runkle
    Cleveland Clinic Cole Eye Insitute, Cleveland, Ohio, United States
    Cleveland Clinic Lerner College of Medicine of Case Western Reserve University , Cleveland, Ohio, United States
  • Sunil K Srivastava
    Cleveland Clinic Cole Eye Insitute, Cleveland, Ohio, United States
  • Peter K Kaiser
    Cleveland Clinic Cole Eye Insitute, Cleveland, Ohio, United States
  • Rishi P Singh
    Cleveland Clinic Cole Eye Insitute, Cleveland, Ohio, United States
  • Justis P Ehlers
    Cleveland Clinic Cole Eye Insitute, Cleveland, Ohio, United States
  • Footnotes
    Commercial Relationships   Anne Runkle, None; Sunil Srivastava, Allergan (R), Bausch and Lomb (C), Bioptigen (P), Carl Zeiss Meditec (C), Leica (C), Santen (C), Synergetics (P); Peter Kaiser, Alcon (C), Bausch and Lomb (C), Bayer (C), Carl Zeiss Meditec (C), Genentech (C), Neurotech (C), Novartis (C), Ohr (C), Ophthotech (C), Oraya (C), Regeneron (C), Topcon (C); Rishi Singh, Carl Zeiss Meditec (C); Justis Ehlers, Alcon (C), Bioptigen (C), Bioptigen (F), Bioptigen (P), Carl Zeiss Meditec (C), Carl Zeiss Meditec (F), Genentech (F), Leica (C), Leica (F), Leica (P), Regeneron (F), Santen (C), Synergetics (P), Thrombogenics (C), Thrombogenics (F)
  • Footnotes
    Support  NIH 1T32EY024236-01A1, NIH/NEI K23-EY022947-01A1, Ohio Department of Development TECH-13-059
Investigative Ophthalmology & Visual Science September 2016, Vol.57, No Pagination Specified. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Anne Runkle, Sunil K Srivastava, Peter K Kaiser, Rishi P Singh, Justis P Ehlers; Factors Associated with Development of Dissociated Optic Nerve Fiber Layer (DONFL) Appearance in the PIONEER Study. Invest. Ophthalmol. Vis. Sci. 201657(12):.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
Abstract

Purpose : The cause of the Dissociated Optic Nerve Fiber Layer (DONFL) appearance after membrane peeling for vitreomacular interface (VMI) disorders remains unknown. We used intraoperative OCT (iOCT) to examine the relationship between retinal alterations during membrane peeling and postoperative development of DONFL appearance.

Methods : This was a post-hoc analaysis of eyes undergoing membrane peeling for VMI disorders in the PIONEER study, an IRB-approved prospective study examining iOCT in ophthalmic surgery. A microscope mounted SD-OCT probe (Bioptigen) was used to obtain pre-incision and post-peel iOCT images. Exclusion criteria included lack of follow-up OCT from 3-12 months postoperatively and poor iOCT or postoperative OCT image quality. iOCT images were assessed for microarchitectural changes including inner, middle, and outer retinal thickness. Clinical variables assessed included indication for surgery and membrane peeling technique (e.g., diamond-dusted membrane scraper [DDMS], forceps). Primary outcome was development of DONFL appearance on 6 month follow-up SD-OCT.

Results : Ninety-nine eyes were included in the study. Preoperative diagnosis included epiretinal membrane (ERM) in 54 eyes (55%), macular hole (MH) in 41 eyes (42%), and vitreomacular traction syndrome (VMT) in 3 eyes (3%). The OCT-based prevalence of DONFL appearance at 6 months was 33%. Prevalence of DONFL appearance was 9.3% in eyes with ERM and 63.4% in eyes with MH. In eyes where forceps alone were used for membrane peeling, prevalence of DONFL appearance was 30.4%, while in eyes where DDMS was used, prevalence was 34.6% (p=0.66). Quantitative analysis of iOCT and acute postoperative retinal layer changes identified increased inner retinal layer thickness as a significant factor associated with postoperative development of DONFL appearance (p = 0.02).

Conclusions : Acute increase in inner retinal thickness and MH repair were associated with the development of DONFL appearance after membrane peeling. This suggests that one mechanism in the development of DONFL appearance may be intraoperative trauma to the inner retina as well as with peeling of the internal limiting membrane (e.g., MH repair). Additionally, this study showed no difference in development of DONFL appearance between forceps-only technique and use of DDMS for peel initiation.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

En face SD-OCT of (A) Severe DONFL and (B) no DONFL appearance.

En face SD-OCT of (A) Severe DONFL and (B) no DONFL appearance.

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×