Inner retinal surface abnormalities: Imaging phenotypes, quantitative features, and mechanistic insights across...

Advances in cross-sectional and en face optical coherence tomography have revealed a spectrum of subtle inner retinal changes that occur in both surgical and non-surgical conditions. Among these, inner retinal dimples (IRDs), also referred to as dissociated optic nerve fiber layer (DONFL) appearance, concentric macular dark spots (CMDS), and transient swollen arcuate nerve fiber layer (SANFL) have been described in eyes undergoing internal limiting membrane (ILM) peeling, most commonly for macular hole or epiretinal membrane while paravascular inner retinal defects (PIRD), micro-holes, and clefts have been reported in highly myopic eyes and tractional conditions even without prior surgery. The multiplicity of terms, some modality-dependent, others descriptive of etiology has obscured the relationships among these entities, causing confusion in clinical interpretation and research communication. Herein, we propose a hypothesis-driven conceptual and terminological framework intended to reconcile these disparate observations within a coherent schema grounded in anatomy and imaging phenotype while recognizing that the available evidence remains predominantly retrospective and heterogeneous. By reviewing multimodal imaging studies we clarify that postoperative IRDs, DONFL, CMDS, and SANFL may reflect a remodeling response of the inner retina (largely due to ILM removal/peeling, either surgical or spontaneous) whereas PIRD and its variants stem from chronic biomechanical or tractional stress. The review examines their morphological characteristics, temporal evolution, and available data on structure-function correlations. Standardizing nomenclature and interpretation will enhance clarity in both surgical outcomes assessment and clinical management of myopic or tractional retinal disease.