Purchase this article with an account.
David Steel, Christiana Dinah; The relationship between a 'Dissociated optic nerve fibre layer' appearance and the extent of retinal and vitreous 'debris' on internal limiting membrane following surgery for idiopathic macular holes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1160.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Internal limiting membrane (ILM) peeling results in a variable amount of post operatively observable changes in the inner retina following surgery for idiopathic macular hole - the distinctive appearance of which has been termed a 'Dissociated optic nerve fibre layer' (DONFL). DONFL has been attributed to Muller cell trauma from peeling. This study was performed to assess the relationship between the extent of retinal cell debris on peeled ILM during macular hole surgery and the degree of postoperative DONFL observed. We also wished to assess whether the extent of debris on the vitreous side of the ILM affected the extent of retinal cell debris and could be related to the staining pattern of the ILM specific stain Brilliant Blue G (BBG) used.
A consecutive series of patients with idiopathic macular hole underwent surgery with vitrectomy and ILM peeling.The staining pattern of the BBG on the retinal surface was recorded and divided into uniform, patchy and non. After removal from the eye the ILM was fixed, subjected to transmission electron microscopy (TEM) and the extent of debris on the vitreous and retinal sides was quantified. Post operatively the extent of DONFL was quantified at 3 months postoperatively on SD OCT.
Twenty patients (20 eyes) were studied. TEM showed variable amounts of vitreous debris covering from 11-82% of the ILM surface.The amount of cellular debris on the vitreous side on TEM correlated well with the amount of non staining visible clinically. The amount of retinal surface with retinal cell debris on ranged from 15-56%. DONFL was observed in 50% of the patients on colour photography and 80% on blue reflectance photography. There was no significant correlation between the number of DONFL lesions and the amount of retinal cell debris nor between the staining pattern and DONFL lesions.
The staining pattern of BBG on the ILM observed clinically correlates well with the amount of cellular debris observable histologically on TEM. The degree of cellular debris on the vitreous side does not appear to have any influence on the plane of separation of the ILM from the retina. The amount of debris on the retinal side of the ILM on TEM does not relate to the post operative appearance of DONFL observed.
This PDF is available to Subscribers Only