June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Bidirectional dimple and visual prognosis after internal limiting membrane peeling for a macular hole
Author Affiliations & Notes
  • Jaeryung Oh
    Department of Ophthalmology, Korea University College of Medicine, Seoul, Foreign, Korea (the Republic of)
  • Young Ho Kim
    Department of Ophthalmology, Korea University College of Medicine, Seoul, Foreign, Korea (the Republic of)
  • Myung-Sun Song
    Department of Ophthalmology, Korea University College of Medicine, Seoul, Foreign, Korea (the Republic of)
  • Ariunaa Togloom
    Department of Ophthalmology, Korea University College of Medicine, Seoul, Foreign, Korea (the Republic of)
  • Kyung-Sook Yang
    Department of Biostatistics, Korea University College of Medicine, Seoul, Korea (the Republic of)
  • So Min Ahn
    Department of Ophthalmology, Korea University College of Medicine, Seoul, Foreign, Korea (the Republic of)
  • Cheolmin Yun
    Department of Ophthalmology, Korea University College of Medicine, Seoul, Foreign, Korea (the Republic of)
  • Footnotes
    Commercial Relationships   Jaeryung Oh None; Young Ho Kim None; Myung-Sun Song None; Ariunaa Togloom None; Kyung-Sook Yang None; So Min Ahn None; Cheolmin Yun None
  • Footnotes
    Support  This work was supported by the Korea University grant (K2208351) and by the Korea Medical Device Development Fund grant funded by the Korean government (Ministry of Science and ICT, Ministry of Trade, Industry and Energy, Ministry of Health & Welfare, Ministry of Food and Drug Safety) (Project Number: 1711174316, RS-2020-KD000026).
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 5264. doi:
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      Jaeryung Oh, Young Ho Kim, Myung-Sun Song, Ariunaa Togloom, Kyung-Sook Yang, So Min Ahn, Cheolmin Yun; Bidirectional dimple and visual prognosis after internal limiting membrane peeling for a macular hole. Invest. Ophthalmol. Vis. Sci. 2023;64(8):5264.

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      © ARVO (1962-2015); The Authors (2016-present)

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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.

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