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Jesia Hasan, Sweta Tarigopula, John C. Chen; Internal Limiting Membrane Peel in Macular Hole Surgery as a cause of Retinal Nerve Fiber Layer Damage on Spectral Domain Ocular Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2615.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze retinal nerve fiber layer appearance in eyes after macular hole (MH) surgery, with and without indocyanine green (ICG) staining, using spectral domain optical coherence tomography (SD-OCT).
A prospective comparative cohort study, in which 30 eyes of 29 patients undergoing surgery for stage 3 macular holes were selected from the practice of a single vitreoretinal surgeon between December 2009 and September 2011. All patients underwent pars plana vitrectomy (PPV) with iatrogenic posterior vitreous detachment. Patients were divided into 3 groups: 1. No internal limiting membrane (ILM) peeling 2. ILM peeling with no dye assistance 3. ICG-assisted ILM peeling. All patients had SD-OCT on average 3 months postoperatively.
At one month following surgery, 30 eyes (100%) had successful MH closure. Of the posterior vitreous detachment (PVD) only group, none demonstrated postoperative retinal nerve fiber layer (RNFL) changes. Seventy percent of the ILM peel only group and 60% of the ICG-assisted ILM peel group showed discrete perimacular RFNL irregularities on SD-OCT (P < 0.05).
The present study shows an association between retinal nerve fiber layer defects in the perimacular area and eyes which underwent macular hole surgery with ILM peeling. These RNFL findings are consistent with mechanical damage from ILM peel. ICG-assisted ILM peeling did not appear to reduce the number of RNFL defects. Our study suggests that, in selected cases, PPV with posterior hyaloid detachment alone may be sufficient for stage 3 macular hole surgery with minimum damage to retinal nerve fiber layer.
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