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. 2018 Sep;38 Suppl 1(Suppl 1):S103-S109.
doi: 10.1097/IAE.0000000000002017.

FACTORS ASSOCIATED WITH DEVELOPMENT OF DISSOCIATED OPTIC NERVE FIBER LAYER APPEARANCE IN THE PIONEER INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY STUDY

Anne P Runkle  1   2 , Sunil K Srivastava  1   2 , Alex Yuan  1   2 , Peter K Kaiser  1   2 , Rishi P Singh  1   2 , Jamie L Reese  1   2 , Justis P Ehlers  1   2
Affiliations

FACTORS ASSOCIATED WITH DEVELOPMENT OF DISSOCIATED OPTIC NERVE FIBER LAYER APPEARANCE IN THE PIONEER INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY STUDY

Anne P Runkle et al. Retina. 2018 Sep.

Abstract

Purpose: To assess the relationship of dissociated optic nerve fiber layer (DONFL) and intraoperative membrane-peeling dynamics as visualized using intraoperative optical coherence tomography (OCT), and to evaluate the functional implications of DONFL.

Methods: This was a post hoc analysis of eyes undergoing membrane peeling for vitreomacular interface disorders in the prospective PIONEER intraoperative OCT study. Retinal layer measurements in preincision and postpeel intraoperative OCT images were obtained. The primary outcome was development of DONFL appearance on spectral domain OCT at 6-month follow-up. Secondary outcomes included correlation of DONFL with surgical technique, surgical indication, intraoperative OCT findings, and retinal sensitivity.

Results: Ninety-five eyes were included. The prevalence of DONFL at 6 months was 36%. Increased inner retinal layer thickness on intraoperative OCT immediately after membrane peeling was associated with development of DONFL (P < 0.01). Macular hole repair was significantly associated with DONFL appearance. Peel technique (forceps vs. diamond-dusted membrane scraper) was not associated with DONFL. There was no difference in retinal sensitivity or visual acuity between eyes with or without DONFL.

Conclusion: Acute postpeel increase in inner retinal thickness and macular hole repair were associated with development of DONFL appearance. However, it is unclear whether the surgical indication (e.g., macular hole) or the surgical manipulations performed (e.g., internal limiting membrane peeling) is the major factor that has an impact on DONFL appearance. Overall, these findings suggest that one mechanism in the development of DONFL appearance may be intraoperative trauma to the inner retina, potentially during internal limiting membrane peeling (e.g., macular hole repair).

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Figures

Figure 1
Figure 1
Generation of en face intraoperative SD-OCT image using Cirrus Advanced Visualization Software. (A) Final en face image overlaid on fundus photograph. (B) and (C) A “Slab” of 100 micron thickness is fit to the “ILM” layer as recognized by the Cirrus software. (D) The resulting grayscale en face SD-OCT. This example shows clear DONFL appearance.
Figure 2
Figure 2
En face SD-OCT analysis. (A) DONFL present and (B) DONFL absent.
See this image and copyright information in PMC

References

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