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Retinal nerve fiber layer thickness modification after internal limiting membrane peeling.

Nicole Balducci1, Mariachiara Morara, Chiara Veronese

  • 1*Ophthalmology Unit, University of Bologna, Bologna, Italy; †Ophthalmology Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy; and ‡San Giuseppe Hospital, University Eye Clinic, Milan, Italy.

Retina (Philadelphia, Pa.)
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Summary

Internal limiting membrane peeling for macular hole surgery causes temporary retinal nerve fiber layer thickness (RNFLT) increase, followed by a significant reduction in temporal sectors at six months, suggesting potential damage.

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Area of Science:

  • Ophthalmology
  • Retinal Imaging
  • Surgical Outcomes

Background:

  • Internal limiting membrane (ILM) peeling is a common surgical step for idiopathic macular hole (MH) and epiretinal membrane (ERM).
  • Understanding the impact of ILM peeling on the retinal nerve fiber layer thickness (RNFLT) is crucial for assessing surgical outcomes and potential complications.

Purpose of the Study:

  • To evaluate early and late changes in RNFLT after ILM peeling.
  • To correlate RNFLT modifications with visual field indices following surgery for MH or ERM.

Main Methods:

  • Prospective, interventional study of 30 eyes undergoing ILM peeling.
  • Spectral domain optical coherence tomography (SD-OCT) used to measure peripapillary and global RNFLT at baseline and 1, 3, and 6 months postoperatively.
  • Visual field testing performed preoperatively and at 6 months postoperatively.

Main Results:

  • A significant overall increase in RNFLT was observed at 1 month post-surgery, returning to baseline by 3 months.
  • At 6 months, RNFLT significantly decreased in the superotemporal, inferotemporal, and temporal sectors, averaging an 18.2 µm reduction.
  • No significant correlation was found between RNFLT changes and visual field indices.

Conclusions:

  • The transient postoperative RNFLT increase may be attributed to inflammatory responses.
  • The late reduction in temporal RNFLT suggests potential damage to the macular nerve fiber layer from ILM peeling.