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S.R. Tari, O. Vidne–Hay, V.C. Greenstein, D.C. Hood, S. Chang; Effect of ILM Peeling on Retinal Structure and Function . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5416.
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Purpose: There are reports of visual field defects following internal limiting membrane (ILM) peeling for the treatment of macular hole (MH) and macular pucker (MP). To investigate this, measures of retinal function and structure were assessed in patients with macular hole and patients with macular pucker pre–and post–surgery. Methods: Seven patients with MP and five with MH were studied. Visual acuity, slit lamp examination, indirect ophthalmoscopy, fundus photographs, optical coherence tomography (OCT), 10–2 Humphrey visual fields (HVF), and multifocal electroretinograms (mfERG) were performed before, and three months after surgical intervention. The mfERG stimulus consisted of 103 scaled hexagons; the display subtended 50 degrees in diameter. Fixation stability was continuously monitored. First and second–order kernels were analyzed pre–and post surgery, in rings and in areas corresponding to those undergoing ILM peeling. Results: Four of the five MH patients showed successful closure of the macular hole observed both on clinical examination, visual acuity, HVF thresholds and on OCT. Pre–operatively, mfERG P1 amplitudes were markedly decreased or non–recordable in areas corresponding to the hole and decreased surrounding the hole. Latencies were either non–recordable or markedly increased compared to age–similar normals.Post–operatively P1 amplitudes and latencies were improved in areas corresponding to and surrounding the hole. One patient however, showed an increase in latency in the surrounding areas. The seven patients with MP showed improvement in visual acuity following successful removal of the membrane. Pre–operatively, mfERG P1 amplitudes were decreased and latencies increased throughout the tested area compared to values for age–similar normals. Post–operatively latencies and amplitudes improved for four patients. However the other three patients showed some deterioration in mfERG measures in areas corresponding to the peel. Conclusions: In assessing the outcome of treatment for MH and MP, visual acuity, OCT and standard clinical examinations do not provide a complete assessment of the extent of visual dysfunction. The mfERG and HVF thresholds provide valuable functional information regarding the treated and non–treated areas.
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