J Korean Ophthalmol Soc.  2014 Dec;55(12):1860-1867. 10.3341/jkos.2014.55.12.1860.

ILM Peeling Size and Postoperative Foveal Tissue Elongation in Macular Hole Surgery

• Park JH
• Jeon HM
• Yoon HS

• KMID: 2338977
• DOI: http://doi.org/10.3341/jkos.2014.55.12.1860

Abstract

PURPOSE
To evaluate the relationship between the size of internal limiting membrane (ILM) peeling and the elongation of foveal tissue after macular hole (MH) surgery.
METHODS
The medical records of 29 patients (29 eyes) who developed elongation of foveal tissue on spectral domain optical coherence tomography (OCT) after vitrectomy with ILM peeling and gas tamponade for idiopathic MH were retrospectively reviewed. These eyes were classified into 3 subgroups by the size of ILM peeling: group A (9 eyes), smaller than 2 disc diameter (DD); group B (12 eyes), larger than 2 DD and within the major temporal vascular arcade, and group C (8 eyes), till the edge of the major temporal vascular arcade. Inter-outer plexiform layer (OPL) distance, representing elongation of foveal tissue, was measured 1, 3, and 6-8 months (only 18 eyes) postoperatively. 'Asymmetric elongation' was defined as non-uniform elongation of the foveal tissue in certain directions.
RESULTS
Horizontal/vertical inter-OPL distances 1 month postoperative, in descending order, were: group B, 436.58 +/- 88.54 / 404.92 +/- 78.55 microm; group A, 421.33 +/- 109.97 / 404.14 +/- 120.9 microm; and C group, 389.25 +/- 48.75 / 400 +/- 52.23 microm. Variations in the horizontal/vertical inter-OPL distance 3 months after MH surgery were: group B, 136.83 +/- 65.64 / 103.92 +/- 73.37 microm; group A, 88.11 +/- 41.57 / 75.89 +/- 53.18 microm; and group C, 140.25 +/- 68.51 / 83.63 +/- 56.62 microm. There were no significant differences in inter-OPL distance, variation in inter-OPL distance, or percent asymmetry in both horizontal and vertical directions among these groups.
CONCLUSIONS
Elongation of the foveal tissue and asymmetric elongation after MH surgery were not associated with the size of ILM peeling.

Keyword

Asymmetry; Elongation; ILM peeling; Macular hole surgery

MeSH Terms

Humans
Medical Records
Membranes
Retinal Perforations*
Retrospective Studies
Tomography, Optical Coherence
Vitrectomy

Figure

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  Figure 1. Classification into 3 subgroups by the size of internal limiting membrane (ILM) peeling. (A) Group A, smaller than 2 DD; (B) group B, larger than 2 DD and within the major temporal vascular arcade, and (C) group C, till the edge of the major temporal vascular arcade.

• 

  Figure 2. The spectral domain optical coherence tomography (SD-OCT) images of 61-year-old female patient representing postoperative elongation of foveal tissue. Note the inter-outer plexiform layer (OPL) distance had been increased over follow-up period. (A) Preoperative state (B) 1 month after macular hole surgery (C) 3 months (D) 6 months.

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  Figure 3. The distance between the edge of outer plexiform layer (OPL) was defined as ‘inter-OPL distance’. The spectral domain optical coherence tomography (SD-OCT) images were taken 1, 3 months after surgery using the 1:1 μm setting. The distance from the center of the foveal cyst to the edge of nasal edge of OPL was defined as N. N = nasal length; T = temporal length.

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  Figure 4. Scatter diagram of inter-outer plexiform layer (OPL) distance and percent asymmetry in each patient along with postoperative period. (A, B) Distribution of the horizontal inter-OPL distance and percent asymmetry. (C, D) Distribution of the vertical inter-OPL distance and percent asymmetry.

Reference

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