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Kazuyuki Nukada, Masanori Hangai, Sotaro Ooto, Nagahisa Yoshimura; Spectral-domain Optical Coherence Tomographic Findings of Dissociated Optic Nerve Fiber Layer Appearance after Internal Limiting Membrane Peeling for Idiopathic Macular Holes. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2150.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the structural characteristics of the dissociated optic nerve fiber layer (DONFL) that appear on color fundus photographs after macular hole surgeries with internal limiting membrane (ILM) peeling by using enhanced spectral-domain optical coherence tomography (SD-OCT).
We reviewed the medical charts of 36 patients (38 eyes) with idiopathic macular holes that were successfully closed after a vitrectomy with ILM peeling between January 2008 and April 2010. Speckle noise-reduced (enhanced) SD-OCT imaging (Spectralis HRA+OCT [Heidelberg Engineering]) was used to delineate the structural characteristics of the DONFL appearance. We analyzed the cross-sectional enhanced SD-OCT images of the DONFL detected in color fundus photographs post surgery.
DONFL appearance was observed in the color fundus photographs of 24 (63.2%) of the 38 reviewed eyes. These features were present in the superior (22 eyes, 91.7%), nasal (17 eyes, 70.8%), inferior (17 eyes, 70.1%), and temporal (13 eyes, 54.2%) quadrants of the macula. Enhanced SD-OCT clearly delineated the ganglion cell layer (GCL) and inner plexiform layer (IPL) in eyes with closed macular holes. On enhanced SD-OCT images, the inner retinal layers showed defects at varying depths along the DONFL appearance; some defects were limited to the retinal nerve fiber layer (RNFL), and others extended beyond the RNFL into the GCL and IPL. The incidence of defects extending beyond the RNFL was more frequent (P < 0.023) in the temporal quadrant (100.0%) than in the superior (63.6%), inferior (23.5%), and nasal (5.9%) quadrants in eyes with DONFL. Inner retinal defects were also noted in 12 (85.7%) of the 14 eyes than did not show DONFL appearance on their color funds photographs.
Enhanced SD-OCT images revealed that retinal layer defects involving the GCL and IPL occur along with DONFL appearance in eyes with macular holes treated with ILM peeling.
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