[Long-term observation of morphological changes of the inner retinal after internal limiting membrane peeling in...

Objective: To investigate the characteristics of morphological changes of inner retinal layer after internal limiting membrane peeling in macular hole surgery. Methods: Retrospective case study. Patients with idiopathic macular hole from 2015 to 2018 underwent vitrectomy+internal limiting membrane peeling (inverting)+ gas tamponade in China-Japan Friendship Hospital were investigated. A total of 19 eyes (17 patients) were enrolled, including 4 males (4 eyes) and 13 females (15 eyes). The average age was 62.74±5.25 years. Optical coherence tomography (OCT) was used to obtain the topographic maps of retinal thickness, the thickness of retinal ganglion cell complex and probability maps, and the Angio/en-face maps of macular retina. The characteristics of the morphological changes of the inner retinal were comprehensively analyzed. Results: Among 19 eyes, 9 eyes had internal limiting membrane peeling, 8 eyes had lotus-like internal limiting membrane inverting, and 2 eyes had the uper180 degrees internal limiting membrane inverting. The minimum diameter of macular hole was (543.06+220.17) μm and the maximum diameter was (947.18+319.12) μm. The follow-up time was (21.05+9.66) months, and the visual acuity was 0.45+0.35 at the last follow-up. In the 19 eyes, all the macular holes were closed postoperatively and dissociated optic nerve fiber layer appearance (DONFL) and concentric macular dark spots (CMDS) all showed, as well as mGCC thinning. The changes of CMDS and mGCC in 2 eyes in the uper180 degrees internal limiting membrane inverting group were mainly seen in the upper retina and in the remaining 17 eyes were seen diffused around the macula, which roughly corresponded to the extent of internal limiting membrane peeling. Two eyes showed clear decrease of retinal capillary density on Angio/map. Conclusions: Long-term morphological changes of the inner retinal after internal limiting membrane peeling in macular hole surgery are obvious. In addition to the appearance changes like DONFL and CMDS, the macular ganglion cell complex (mGCC) is also involved. (Chin J Ophthalmol, 2019, 55:747-756).