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'Dissociated optic nerve fiber layer appearance' after internal limiting membrane removal is inner retinal dimpling

机译：内部限制膜去除后“分离的视神经纤维层外观”是视网膜内陷

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PURPOSE: To examine volume-rendered spectral-domain optical coherence tomography images in patients who had undergone vitrectomy, many of whom had internal limiting membrane removal to investigate a condition termed "dissociated optic nerve fiber layer appearance." METHODS: Patients who had undergone vitrectomy for either macular hole or epiretinal membrane were evaluated. Spectral-domain optical coherence tomography B-scan images were acquired with the use of eye tracking at an interval of either 30 μm or 60 μm. These were registered and exported to a volume-rendering program, and the resultant volume-rendered images were evaluated. The images were graded for the presence of inner retinal abnormalities, and correlates were made to corresponding alterations seen in fundus photographs and B-scan spectral-domain optical coherence tomography images. RESULTS: There were 25 eyes of 24 patients with a mean age of 72.4 (±7.3) years, 15 of whom were women. The primary preoperative diagnosis was macular hole in 10 eyes (40%) and epiretinal membrane in 15 eyes (60%). As part of the surgery, 18 eyes (72%) had planned peeling of the internal limiting membrane. Volume rendering showed that 13 eyes had pitting or dimples of the inner retinal surface that seemed to follow the course of the nerve fiber layer in the region of the macula. The inner retinal dimples occurred only in eyes that had internal limiting membrane peeling. Correlation of the volume-rendered images with B-scan spectral-domain optical coherence tomography showed focal areas of thinning of the ganglion cell layer with decreased reflectivity from the nerve fiber layer in the areas of the dimples. CONCLUSION: A high proportion of eyes with internal limiting membrane peeling develop inner retinal dimples that course along the path of the nerve fiber layer. The dimples seem to be the result of an interplay between trauma and healing processes constrained by nerve fiber layer and do not appear to be because of dissociation of optic nerve fibers. The true nature of the abnormalities induced should be investigated to evaluate the long-term risks and benefits of routine internal limiting membrane peeling.
机译：目的：在接受玻璃体切除术的患者中检查体积渲染的光谱域光学相干断层扫描图像，其中许多患者具有内膜切除限制，以研究一种称为“游离视神经纤维层外观”的疾病。方法：对接受玻璃体切除术治疗黄斑裂孔或视网膜前膜的患者进行评估。使用眼动追踪以30μm或60μm的间隔获取光谱域光学相干断层扫描B扫描图像。将它们注册并导出到体绘制程序，然后评估所得的体绘制图像。根据内部视网膜异常的存在对图像进行分级，并将其与眼底照片和B扫描光谱域光学相干断层扫描图像中看到的相应变化进行关联。结果：24例患者中有25眼，平均年龄为72.4（±7.3）岁，其中15例为女性。术前主要诊断为10眼（40％）为黄斑裂孔和15眼（60％）为视网膜前膜。作为手术的一部分，计划有18只眼（72％）计划剥离内部限制膜。体积渲染显示13只眼睛的视网膜内侧表面有凹痕或酒窝，似乎沿着黄斑区域的神经纤维层运动。视网膜内侧酒窝仅发生在具有内部限制膜剥离的眼睛中。 B扫描光谱域光学相干断层扫描的体绘制图像的相关性显示神经节细胞层变薄的焦点区域，在酒窝区域神经纤维层的反射率降低。结论：很大一部分具有内部限制膜剥离的眼睛会形成沿神经纤维层路径行进的内部视网膜酒窝。酒窝似乎是受神经纤维层约束的创伤与愈合过程之间相互作用的结果，并且似乎不是由于视神经纤维的解离。应该研究引起的异常的真实性质，以评估常规内部限制膜剥离的长期风险和益处。

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