Ito Yasuki, Terasaki Hiroko, Takahashi Akiko, Yamakoshi Tomomi, Kondo Mineo, Nakamura Makoto
Department of Ophthalmology, Nagoya University School of Medicine, Nagoya, Japan.
Ophthalmology. 2005 Aug;112(8):1415-20. doi: 10.1016/j.ophtha.2005.02.023.
To investigate the characteristics and incidence of a dissociated optic nerve fiber layer (DONFL) appearance in eyes after idiopathic macular hole surgery.
Retrospective, nonrandomized, comparative interventional case series.
Ninety-one eyes with idiopathic macular holes that were closed after 1 pars plana vitrectomy were studied. Among these, 67 eyes had the internal limiting membrane (ILM) peeled (ILM-peeled), and 24 did not have the ILM peeled (ILM-unpeeled).
All patients received a complete ophthalmologic examination and color fundus photography preoperatively and postoperatively. Twenty ILM-peeled eyes and 9 ILM-unpeeled eyes were also examined by optical coherence tomography (OCT3), microperimetry by scanning laser ophthalmoscope (SLO), and macular sensitivity measurements by Humphrey visual field testing more than 4 months after the vitrectomy.
Development of a DONFL on fundus photographs and OCT3, and the functional evaluation of a DONFL by best-corrected visual acuity, SLO-microperimetry, and Humphrey visual field testing.
In 67 ILM-peeled eyes, a DONFL appearance was found in 36 eyes (54%) in color fundus photographs. A DONFL appearance was not detected in any of the 24 ILM-unpeeled eyes. Focal dehiscence of the optic nerve fiber layer was found in all 20 examined eyes by OCT3. No scotoma was found corresponding to the DONFL by SLO microperimetry. The best-corrected visual acuity and macular sensitivity were not significantly different in eyes with and without a DONFL appearance (P>0.05). A DONFL appearance was not detected in all 20 eyes examined within 1 month after surgery, was detected in all 16 eyes examined between 1 and 3 months, and no new cases were detected after 3 months. The DONFL appearance became more distinct until about 6 months after first detection and seemed not to change subsequently.
The DONFL appearance in about half of the eyes with ILM peeling and none in eyes without ILM peeling strongly suggest that the DONFL appearance is related to ILM peeling. The OCT findings in eyes with no functional abnormality by SLO microperimetry suggested that the DONFL is due to a dehiscence of the optic nerve fiber layer and not a true nerve fiber layer defect.
研究特发性黄斑裂孔手术后眼内出现的视神经纤维层分离（DONFL）外观的特征及发生率。
回顾性、非随机、对比性干预病例系列研究。
91例特发性黄斑裂孔患者，在进行1次经睫状体平坦部玻璃体切除术后裂孔闭合。其中，67只眼进行了内界膜（ILM）剥除（ILM剥除组），24只眼未进行ILM剥除（ILM未剥除组）。
所有患者在术前和术后均接受了全面的眼科检查及彩色眼底照相。20只ILM剥除组眼和9只ILM未剥除组眼在玻璃体切除术后4个月以上还接受了光学相干断层扫描（OCT3）、扫描激光检眼镜微视野检查（SLO）以及Humphrey视野检测黄斑敏感度。
眼底照片和OCT3上DONFL的出现情况，以及通过最佳矫正视力、SLO微视野检查和Humphrey视野检测对DONFL进行功能评估。
在67只ILM剥除组眼中，36只眼（54%）在彩色眼底照片上出现了DONFL外观。24只ILM未剥除组眼中均未检测到DONFL外观。通过OCT3在所有20只检查眼中均发现了视神经纤维层的局灶性裂开。SLO微视野检查未发现与DONFL相对应的暗点。有和没有DONFL外观的眼之间，最佳矫正视力和黄斑敏感度无显著差异（P>0.05）。术后1个月内检查的所有20只眼中均未检测到DONFL外观，1至3个月检查时所有16只眼中均检测到DONFL外观，3个月后未发现新病例。DONFL外观在首次检测后约6个月内变得更加明显，随后似乎不再变化。
约一半的ILM剥除组眼中出现DONFL外观而ILM未剥除组眼中均未出现，这强烈提示DONFL外观与ILM剥除有关。SLO微视野检查未发现功能异常的眼中的OCT结果表明，DONFL是由于视神经纤维层裂开而非真正的神经纤维层缺陷所致。
