Purpose: To investigate the incidence of and risk factors for a dissociated optic nerve fiber layer (DONFL) appearance after pars plana vitrectomy (PPV). Methods: We retrospectively reviewed 189 eyes that underwent PPV with internal limiting membrane removal and judged the presence/absence of an apparent DONFL based on en face layer images produced by spectral-domain optical coherence tomography (SD-OCT). Results: An apparent DONFL was observed in 47 (24.9%) eyes. The incidence of an apparent DONFL was significantly higher in the macular hole (MH) group (76.5%) than in the non-MH group (epiretinal membrane, diabetic macular edema, retinal vein occlusion, and others; 4.9%; p < 0.001). In the logistic regression analysis, surgical indication for MH was identified as the most significant DONFL risk factor (odds ratio 63.7; p = 1.05 × 10-8). Conclusion: Postoperative OCT en face layer imaging clarified that MH eyes are liable to have an apparent DONFL following PPV.

Keywords:
Dissociated optic nerve fiber layer, Imaging, Internal limiting membrane, Macular hole, Optical coherence tomography, Retina, Vitrectomy
1.
Geitzenauer W, Hitzenberger CK, Schmidt-Erfurth UM: Retinal optical coherence tomography: past, present and future perspectives. Br J Ophthalmol 2011;95:171-177.
2.
Schocket LS, Witkin AJ, Fujimoto JG, Ko TH, Schuman JS, Rogers AH, Baumal C, Reichel E, Duker JS: Ultrahigh-resolution optical coherence tomography in patients with decreased visual acuity after retinal detachment repair. Ophthalmology 2006;113:666-672.
3.
Chang LK, Koizumi H, Spaide RF: Disruption of the photoreceptor inner segment-outer segment junction in eyes with macular holes. Retina 2008;28:969-975.
4.
Koizumi H, Spaide RF, Fisher YL, Freund KB, Klancnik JM Jr, Yannuzzi LA: Three-dimensional evaluation of vitreomacular traction and epiretinal membrane using spectral-domain optical coherence tomography. Am J Ophthalmol 2008;145:509-517.
5.
Glittenberg C, Krebs I, Falkner-Radler C, Zeiler F, Haas P, Hagen S, Binder S: Advantages of using a ray-traced, three-dimensional rendering system for spectral domain Cirrus HD-OCT to visualize subtle structures of the vitreoretinal interface. Ophthalmic Surg Lasers Imaging 2009;40:127-134.
6.
Gupta V, Gupta A, Gupta P, Sharma A: Spectral-domain cirrus optical coherence tomography of choroidal striations seen in the acute stage of Vogt-Koyanagi-Harada disease. Am J Ophthalmol 2009;147:148-153.e2.
7.
Kim NM, Park HJ, Koo GH, Lee JE, Oum BS: Photoreceptor layer assessed in tissue layer image using spectral-domain optical coherence tomography after surgical closure of macular hole. Retina 2011;31:1483-1492.
8.
Kishimoto H, Kusuhara S, Matsumiya W, Nagai T, Negi A: Retinal surface imaging provided by Cirrus high-definition optical coherence tomography prominently visualizes a dissociated optic nerve fiber layer appearance after macular hole surgery. Int Ophthalmol 2011;31:385-392.
9.
Tadayoni R, Paques M, Massin P, Mouki-Benani S, Mikol J, Gaudric A: Dissociated optic nerve fiber layer appearance of the fundus after idiopathic epiretinal membrane removal. Ophthalmology 2001;108:2279-2283.
10.
Alkabes M, Salinas C, Vitale L, Bures-Jelstrup A, Nucci P, Mateo C: En face optical coherence tomography of inner retinal defects after internal limiting membrane peeling for idiopathic macular hole. Invest Ophthalmol Vis Sci 2011;52:8349-8355.
11.
Spaide RF: ‘Dissociated optic nerve fiber layer appearance' after internal limiting membrane removal is inner retinal dimpling. Retina 2012;32:1719-1726.
12.
Kim KY, Yu SY, Kim M, Kim ES, Kwak HW: Morphological change of inner retinal layer on spectral-domain optical coherence tomography following macular hole surgery. Ophthalmologica 2013;230:18-26.
13.
Mitamura Y, Ohtsuka K: Relationship of dissociated optic nerve fiber layer appearance to internal limiting membrane peeling. Ophthalmology 2005;112:1766-1770.
14.
Ito Y, Terasaki H, Takahashi A, Yamakoshi T, Kondo M, Nakamura M: Dissociated optic nerve fiber layer appearance after internal limiting membrane peeling for idiopathic macular holes. Ophthalmology 2005;112:1415-1420.
15.
Nukada K, Hangai M, Ooto S, Yoshikawa M, Yoshimura N: Tomographic features of macula after successful macular hole surgery. Invest Ophthalmol Vis Sci 2013;54:2417-2428.
16.
Imai H, Ohta K: Microperimetric determination of retinal sensitivity in areas of dissociated optic nerve fiber layer following internal limiting membrane peeling. Jpn J Ophthalmol 2010;54:435-440.
17.
Haritoglou C, Ehrt O, Gass CA, Kristin N, Kampik A: Paracentral scotomata: a new finding after vitrectomy for idiopathic macular hole. Br J Ophthalmol 2001;85:231-233.
18.
Ishikawa F, Ogino N, Okita K, Saitou Y, Handa M, Atsumi K: Retinal nerve fiber layer defect after vitrectomy and internal limiting membrane peeling for idiopathic macular hole and epiretinal membrane. Rinsho Ganka 2001;55:1539-1544.
19.
Tamura K, Matsui Y, Iwao K, Sugimoto T, Ogawa K, Morisawa A, Ishigooka H, Ogino N: Findings simulating retinal nerve fiber layer defect following peeling of internal limiting membrane. Rinsho Ganka 2002;56:1601-1605.
20.
Schulze-Bonsel K, Feltgen N, Burau H, Hansen L, Bach M: Visual acuities ‘hand motion' and ‘counting fingers' can be quantified with the Freiburg visual acuity test. Invest Ophthalmol Vis Sci 2006;47:1236-1240.
21.
Haritoglou C, Gandorfer A, Kampik A: NFL appearance after peeling. Ophthalmology 2006;113:1690; author reply 1690-1691.
22.
Fabian ID, Moisseiev J: Sutureless vitrectomy: evolution and current practices. Br J Ophthalmol 2011;95:318-324.
23.
La Heij EC, Dieudonne SC, Mooy CM, Diederen RM, Liem AT, van Suylen RJ, Hendrikse F: Immunohistochemical analysis of the internal limiting membrane peeled with infracyanine green. Am J Ophthalmol 2005;140:1123-1125.
24.
Kenawy N, Wong D, Stappler T, Romano MR, Das RA, Hebbar G, Prime W, Heimann H, Gibran SK, Sheridan CM, Cheung YH, Hiscott PS: Does the presence of an epiretinal membrane alter the cleavage plane during internal limiting membrane peeling? Ophthalmology 2010;117:320-323.e1.
25.
Tamura K, Yokoyama T, Ebihara N, Murakami A: Histopathologic analysis of the internal limiting membrane surgically peeled from eyes with diffuse diabetic macular edema. Jpn J Ophthalmol 2012;56:280-287.
26.
Nakamura T, Murata T, Hisatomi T, Enaida H, Sassa Y, Ueno A, Sakamoto T, Ishibashi T: Ultrastructure of the vitreoretinal interface following the removal of the internal limiting membrane using indocyanine green. Curr Eye Res 2003;27:395-399.
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2014
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