Ophthalmic Imaging Center, Cleveland Clinic, Cleveland, Ohio.
Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
Retina. 2018 Sep;38 Suppl 1(Suppl 1):S103-S109. doi: 10.1097/IAE.0000000000002017.
To assess the relationship of dissociated optic nerve fiber layer (DONFL) and intraoperative membrane-peeling dynamics as visualized using intraoperative optical coherence tomography (OCT), and to evaluate the functional implications of DONFL.
This was a post hoc analysis of eyes undergoing membrane peeling for vitreomacular interface disorders in the prospective PIONEER intraoperative OCT study. Retinal layer measurements in preincision and postpeel intraoperative OCT images were obtained. The primary outcome was development of DONFL appearance on spectral domain OCT at 6-month follow-up. Secondary outcomes included correlation of DONFL with surgical technique, surgical indication, intraoperative OCT findings, and retinal sensitivity.
Ninety-five eyes were included. The prevalence of DONFL at 6 months was 36%. Increased inner retinal layer thickness on intraoperative OCT immediately after membrane peeling was associated with development of DONFL (P < 0.01). Macular hole repair was significantly associated with DONFL appearance. Peel technique (forceps vs. diamond-dusted membrane scraper) was not associated with DONFL. There was no difference in retinal sensitivity or visual acuity between eyes with or without DONFL.
Acute postpeel increase in inner retinal thickness and macular hole repair were associated with development of DONFL appearance. However, it is unclear whether the surgical indication (e.g., macular hole) or the surgical manipulations performed (e.g., internal limiting membrane peeling) is the major factor that has an impact on DONFL appearance. Overall, these findings suggest that one mechanism in the development of DONFL appearance may be intraoperative trauma to the inner retina, potentially during internal limiting membrane peeling (e.g., macular hole repair).
评估术中应用光学相干断层扫描（OCT）观察到的分离性视神经纤维层（DONFL）与术中膜剥离动力学之间的关系，并评估 DONFL 的功能意义。
这是一项前瞻性 PIONEER 术中 OCT 研究中对玻璃体黄斑界面疾病进行膜剥离手术的眼部的事后分析。在术前和术中 OCT 图像中获取视网膜层测量值。主要结局是在 6 个月随访时出现光谱域 OCT 上的 DONFL 外观。次要结局包括 DONFL 与手术技术、手术适应证、术中 OCT 发现和视网膜敏感性的相关性。
共纳入 95 只眼。6 个月时 DONFL 的患病率为 36%。术中 OCT 显示膜剥离后即刻内层视网膜厚度增加与 DONFL 的发生有关（P<0.01）。黄斑裂孔修复与 DONFL 的出现明显相关。剥膜技术（镊与钻石磨膜刮匙）与 DONFL 无关。有无 DONFL 的眼之间的视网膜敏感性或视力无差异。
急性术后内层视网膜厚度增加和黄斑裂孔修复与 DONFL 外观的发展有关。然而，尚不清楚手术适应证（例如黄斑裂孔）或进行的手术操作（例如内界膜剥除）是否是对 DONFL 外观有影响的主要因素。总体而言，这些发现表明 DONFL 外观发展的一个机制可能是内视网膜的术中创伤，可能发生在内界膜剥除（例如黄斑裂孔修复）期间。
