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Alisa J Prager, Dana Blumberg, Qun Zeng, Stanley Chang, Tongalp H Tezel; Internal Limiting Membrane Peel is Associated with Increased Ganglion Cell Loss and Poor Visual Outcome in Patients with Primary Open Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4571. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the anatomical and functional outcomes of inner limiting membrane (ILM) peeling in patients with and without glaucoma. <br />
Clinical and HD-OCT data from 6 patients (6 eyes) with primary open angle glaucoma (POAG) and 8 patients (8 eyes) without glaucoma who underwent pars plana vitrectomy and ILM peel for idiopathic epiretinal membrane (ERM) were compared. Change in logMAR visual acuity scores were taken as the primary functional outcome measure. To compare the impact of ILM peeling on anatomical structures, nerve fiber layer (NFL) and total retinal thicknesses were calculated from pre-operative and at least two post-operative HD-OCT scans. For this purpose, HD-OCT images were manually segmented at 9 pre-determined equidistant points at a 6 x 6 mm matrix centered on the fovea. Image analysis software (MetaMorph Imaging Series 4.5) was used to calculate the actual thickness of both layers. Change in NFL and total retinal thicknesses were then plotted against time, and best-fit curves were derived to compare the temporal changes in anatomical variables in both study groups. <br />
There were no differences between the POAG and non-glaucoma groups in terms of age (p=0.72), gender (p=1.0), initial visual acuity (p=0.18), clinical (p=0.06) and OCT follow-up (p=1.0) durations, surgical technique and the use intraoperative dyes (p=1.0). At the end of the follow-up period of 28±14 weeks, glaucoma patients lost an average of 21.2±4.3 letters, while non-glaucoma patients gained an average of 6.5±1.3 letters (Figure 1, p=0.03). The NFL thickness remained the same in non-glaucomatous eyes in contrast to glaucomatous eyes, which revealed significant decrease in NFL thickness (Figure 2, p<0.001). In the POAG group, post-operative functional loss was associated with significant temporal and nasal perifoveolar attenuation of NFL thickness (P<0.001), but not with foveolar NFL loss. <br />
ERM peel with ILM results in attenuation of the NFL in patients with POAG. This may be associated my surgical trauma and/or tighter adhesion of the ILM to the underlying neural tissue due to activated microglia in POAG. <br />
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