Abstract
Purpose :
Changes in the inner retinal layer, known as dimples or dissociated optic nerve fiber layer, have previously been reported following internal limiting membrane (ILM) peeling for macular hole (MH) surgery. However, few studies investigated the microstructural alterations in the deeper retina underlying the inner retinal dimples and their effect on visual prognosis. We performed a retrospective, observational clinical study to investigate retinal changes associated with dimples after ILM peeling for MH and their impact on visual prognosis.
Methods :
We analyzed the swept source optical coherence tomography images and clinical data of patients who underwent surgery for idiopathic MH. The dimples were classified into three degrees based on the extent of alterations in the underlying deep retinal layers: unidirectional, bidirectional, and complicated bidirectional dimples. The occurrence of dimples according to postoperative follow-up period was analyzed using the univariate and multivariable generalized estimating equations (GEE). The univariate and multiple regression analyses were conducted to investigate the correlation between final visual acuity and several parameters.
Results :
In 69 eyes of 69 patients, dimples were found in 97.1% of eyes, with a mean follow-up of 14.0 ± 11.9 months after surgery, and 83.6% of the eyes with dimples had bidirectional dimples. The proportion of eyes with dimples increased from 55.3% at 1 month after surgery to 95.5% at 3 months (odds ratio [OR]: 18.41, 95% confidence interval [CI]: 3.72–91.16, P <0.001), and 97.9% at 6 months (OR: 40.26, 95% CI: 3.39–478.24, P = 0.001). However, the proportion of eyes with complicated bidirectional dimples gradually increased from month 1 (29.8%) to month 3 (46.3%, P = 0.317) and month 6 (64.6%, OR: 4.21, 95% CI: 1.35–13.13, P = 0.006). The final best-corrected visual acuity (BCVA) of eyes with complicated dimples (0.23 ± 0.21) was better than that of eyes without dimples (0.39 ± 0.30) (P = 0.018). However, in the multiple regression analysis, the presence of glial sealing (P < 0.001) and basal hole diameter (P = 0.001) were the only significant risk factors for final BCVA.
Conclusions :
Changes in retinal layers associated with retinal surface dimples after ILM peeling can occur at different retinal depths and times. However, their effects on the visual prognosis are limited.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.