Journal List > J Korean Ophthalmol Soc > v.57(9) > 1010388

Lee and Park: Analysis of Ganglion Cell-Inner Plexiform Layer Thickness after Internal Limiting Membrane Peeling

Abstract

Purpose

To evaluate the ganglion cell-inner plexiform layer (GCIPL) thickness after internal limiting membrane (ILM) peeling with or without intravitreal gas injection (IVGI) or surgical induction of posterior vitreous detachment (PVD).

Methods

Eighty patients who were diagnosed with epiretinal membrane (ERM) or macular hole and who received surgical intervention were retrospectively reviewed. Forty patients were treated with ILM peeling and forty patients were treated with ERM removal, but not with ILM peeling. The patients were categorized according to ILM peeling, IVGI, and surgical induction of PVD. The GCIPL thickness was measured using optical coherence tomography, and the average and sectorial thickness of GCIPL were compared.

Results

The GCIPL thickness in the ILM peeling group significantly decreased (−13.80 ± 22.63 μ m; p < 0.001), but was not significantly different in the ERM removal without ILM peeling group, compared with the preoperative GCIPL thickness (+1.21 ±22.53 μ m; p = 0.546). The difference was statistically significant between the two groups (p = 0.038). In the ILM peeling group, GCIPL thickness was not significantly different in the IVGI group (−17.41 ± 23.92 μ m vs. −7.25 ± 19.05 μ m; p = 0.109) and was significantly decreased in the surgical induction of the PVD group (−23.06 ± 23.92 μ m vs. −7.25 ± 19.05 μ m; p = 0.020). On sectorial analysis, reduction of the temporal GCIPL thickness was the largest and was significantly different compared with the nasal GCIPL thickness in ILM peeling group (−19.73 ± 28.55 μ m vs. −7.42 ± 19.90 μ m; p = 0.005).

Conclusions

ILM peeling and surgical induction of PVD may damage ganglion cells. Therefore, gentle ILM peeling and surgical induction of PVD may be needed to minimize ganglion cell damage, especially when ILM peeling is performed in glaucomatous patients.

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Figure 1.
Preoperative optical coherence tomography (OCT) findings. (A) The spectral domain optical coherence tomography (SD-OCT) images of a patient showing epiretinal membrane. (B) An elliptical annulus (vertical inner and outer diameter of 1.0 mm and 4.0 mm; horizontal inner and outer diameter of 1.2 mm and 4.8 mm, respectively) around the fovea. (C) The ganglion cell anal-ysis algorithm identifies the outer boundary of the retinal nerve fiber layer (purple line) and the outer boundary of the inner plexi-form layer (yellow line). (D) The average, minimum, and sectorial (superior, superotemporal, inferotemporal, inferior, inferonasal, superonasal) thicknesses of the ganglion cell-inner plexiform layer (GCL-IPL) are measured in an elliptical annulus. OS = oculus sinister.
jkos-57-1369f1.tif
Table 1.
Demographic features of patients
Procedure n Procedure n
ILM peeling(+) 40 PVD induced (+) 15
    PVD induced (−) 25
    IVGI (+) 24
    IVGI (−) 16
ILM peeling(−) 40 PVD induced (+) 13
    PVD induced (−) 27
    IVGI (+) 8
    IVGI (−) 32

ILM = internal limiting membrane; PVD = posterior vitreous detachment; IVGI = intravitreal gas injection.

Table 2.
Comparison of GCIPL thickness between the ILM peeling group and the ERM removal without ILM peeling group
GCIPL thickness ILM peeling (+/−) Preoperative (μm) Postoperative (μm) p-value* Difference (μm) p-value
Average (+) 67.67 ± 20.83 53.87 ± 19.86 <0.001 −13.80 ± 22.63 0.038
  (−) 58.05 ± 15.05 59.26 ± 20.14 0.546 1.21 ± 22.53  
Superior (+) 71.89 ± 30.56 54.40 ± 22.48 0.003 −17.49 ± 36.94 0.103
  (−) 57.11 ± 39.04 56.11 ± 25.82 0.872 −1.00 ± 37.68  
Superotemporal (+) 75.11 ± 29.99 51.89 ± 21.56 <0.001 −23.22 ± 35.06 0.027
  (−) 65.31 ± 25.77 63.47 ± 23.03 0.904 −1.84 ± 27.14  
Inferotemporal (+) 67.80 ± 29.04 51.56 ± 22.58 0.001 −16.24 ± 30.50 0.088
  (−) 60.05 ± 21.48 58.74 ± 22.92 0.931 −1.32 ± 33.98  
Inferior (+) 60.91 ± 29.06 49.80 ± 21.58 0.023 −11.11 ± 31.52 0.015
  (−) 46.68 ± 27.21 55.05 ± 23.44 0.151 8.37 ± 35.02  
Inferonasal (+) 62.71 ± 27.15 56.38 ± 21.37 0.088 −6.33 ± 24.36 0.183
  (−) 56.63 ± 13.54 60.53 ± 21.06 0.629 3.89 ± 23.48  
Superonasal (+) 67.82 ± 27.78 59.31 ± 23.82 0.032 −8.51 ± 25.70 0.328
  (−) 61.74 ± 23.42 61.32 ± 19.03 0.904 −0.42 ± 22.87  
Temporal (+) 71.46 ± 25.51 51.72 ± 21.35 <0.001 −19.73 ± 28.55 0.019
  (−) 62.68 ± 19.73 61.11 ± 21.78 0.778 −1.58 ± 27.66  
Nasal (+) 65.27 ± 23.86 57.84 ± 21.48 0.016 −7.42 ± 19.90 0.160
  (−) 59.18 ± 14.77 60.92 ± 19.33 0.673 1.74 ± 20.21  

Values are presented as mean ± SD unless otherwise indicated.

GCIPL = ganglion cell-inner plexiform layer; ILM = internal limiting membrane; ERM = epiretinal membrane.

* Paired t-test

Student's t-test.

Table 3.
Comparison of GCIPL thickness between with or without PVD induction in the ILM peeling group
GCIPL thickness PVD induction (+/−) Preoperative (μm) Postoperative (μm) p-value* Difference (μ m) p-value
Average (+) 77.06 ± 20.86 54.00 ± 22.44 <0.001 −23.06 ± 23.18 0.020
  (−) 61.41 ± 18.66 53.78 ± 18.38 0.107 −7.63 ± 20.42  
Superior (+) 81.89 ± 26.34 50.22 ± 24.34 0.002 −31.67 ± 34.09 0.036
  (−) 65.22 ± 57.19 57.19 ± 21.17 0.442 −8.04 ± 36.29  
Superotemporal (+) 83.17 ± 33.66 51.56 ± 23.19 0.009 −31.61 ± 38.90 0.281
  (−) 69.74 ± 26.58 52.11 ± 20.86 0.012 −17.63 ± 31.78  
Inferotemporal (+) 68.50 ± 28.30 52.33 ± 24.43 0.042 −16.17 ± 30.60 0.763
  (−) 67.33 ± 30.05 51.04 ± 21.73 0.013 −16.30 ± 31.01  
Inferior (+) 74.33 ± 33.39 48.89 ± 23.58 0.007 −25.44 ± 33.60 0.016
  (−) 51.96 ± 22.19 50.41 ± 20.57 0.782 −1.56 ± 26.58  
Inferonasal (+) 75.17 ± 32.13 58.17 ± 25.26 0.035 −17.00 ± 29.59 0.057
  (−) 54.41 ± 19.83 55.19 ± 18.76 0.849 0.78 ± 17.33  
Superonasal (+) 79.83 ± 29.64 62.78 ± 27.99 0.021 −17.06 ± 29.03 0.080
  (−) 59.81 ± 23.77 57.00 ± 20.84 0.866 −2.81 ± 21.97  
Temporal (+) 75.83 ± 26.88 51.94 ± 23.42 0.004 −23.89 ± 30.58 0.431
  (−) 68.54 ± 24.62 51.57 ± 20.32 0.006 −16.96 ± 27.35  
Nasal (+) 77.50 ± 26.42 60.47 ± 25.68 0.004 −17.03 ± 22.01 0.014
  (−) 57.11 ± 18.29 56.09 ± 18.49 0.904 −1.02 ± 15.71  

Values are presented as mean ± SD unless otherwise indicated.

GCIPL = ganglion cell-inner plexiform layer; PVD = posterior vitreous detachment; ILM = internal limiting membrane.

* Mann-Whitney test

Wilcoxon signed rank test.

Table 4.
Comparison of GCIPL thickness between with or without intravitreal gas injection in the ILM peeling group
GCIPL thickness IVGI (+/−) Preoperative (μm) Postoperative (μm) p-value* Difference (μm) p-value
Average (+) 69.55 ± 21.00 52.14 ± 20.51 0.001 −17.41 ± 23.92 0.109
  (−) 64.25 ± 20.75 57.00 ± 18.85 0.214 −7.25 ± 19.05  
Superior (+) 77.07 ± 29.46 51.10 ± 22.79 0.001 −25.97 ± 35.64 0.053
  (−) 62.50 ± 31.22 60.38 ± 21.30 0.959 −2.13 ± 35.22  
Superotemporal (+) 78.41 ± 30.33 48.38 ± 22.80 <0.001 −30.03 ± 35.27 0.034
  (−) 69.13 ± 29.37 58.25 ± 18.06 0.501 −10.88 ± 32.12  
Inferotemporal (+) 69.21 ± 29.88 50.72 ± 33.37 0.010 −18.48 ± 33.37 0.887
  (−) 65.25 ± 28.24 53.06 ± 21.59 0.036 −12.19 ± 24.96  
Inferior (+) 61.41 ± 26.24 50.21 ± 21.56 0.101 −11.21 ± 31.30 0.850
  (−) 60.00 ± 34.50 49.06 ± 22.30 0.244 −10.94 ± 32.96  
Inferonasal (+) 61.86 ± 24.89 55.76 ± 22.32 0.202 −6.10 ± 22.59 0.661
  (−) 64.25 ± 31.66 57.50 ± 20.17 0.589 −6.75 ± 28.07  
Superonasal (+) 69.59 ± 27.27 56.59 ± 24.08 0.013 −13.00 ± 24.94 0.038
  (−) 64.63 ± 29.30 64.25 ± 23.28 0.280 −0.38 ± 25.83  
Temporal (+) 73.81 ± 26.68 49.55 ± 22.76 <0.001 −24.26 ± 30.90 0.135
  (−) 67.19 ± 23.44 55.66 ± 18.58 0.083 −11.53 ± 22.29  
Nasal (+) 65.72 ± 22.57 56.17 ± 22.15 0.016 −9.55 ± 17.79 0.165
  (−) 64.44 ± 26.79 60.88 ± 20.55 0.093 −3.56 ± 23.38  

Values are presented as mean ± SD unless otherwise indicated.

GCIPL = ganglion cell-inner plexiform layer; ILM = internal limiting membrane; IVGI = intravitreal gas injection.

* Mann-Whitney test

Wilcoxon signed rank test.

Table 5.
Comparison of temporal and nasal GCIPL thickness in various groups
GCIPL thickness Sector Preoperative (μ m) Postoperative (μ m) p-value Difference (μ m) p-value
ILM peeling(+) Temporal 71.46 ± 25.51 51.72 ± 21.35 <0.001* −19.73 ± 28.55 0.005
  Nasal 65.27 ± 23.86 57.84 ± 21.48 0.016* −7.42 ± 19.90  
ILM peeling(−) Temporal 62.68 ± 19.73 61.11 ± 21.78 0.778* −1.58 ± 27.66 0.573
  Nasal 59.18 ± 14.77 60.92 ± 19.33 0.673* 1.74 ± 20.21  
ILM peeling with PVD induction Temporal 75.83 ± 26.88 51.94 ± 23.42 0.004 −23.89 ± 30.58 0.287§
  Nasal 77.50 ± 26.42 60.47 ± 25.68 0.004 −17.03 ± 22.01  
ILM peeling without PVD induction Temporal 68.54 ± 24.62 51.57 ± 20.32 0.006 −16.96 ± 27.35 0.004§
  Nasal 57.11 ± 18.29 56.09 ± 18.49 0.904 −1.02 ± 15.71  
ILM peeling with IVGI Temporal 73.81 ± 26.68 49.55 ± 22.76 <0.001 −24.26 ± 30.90 0.005§
  Nasal 65.72 ± 22.57 56.17 ± 22.15 0.016 −9.55 ± 17.79  
ILM peeling without IVGI Temporal 67.19 ± 23.44 55.66 ± 18.58 0.083 −11.53 ± 22.29 0.352§
  Nasal 64.44 ± 26.79 60.88 ± 20.55 0.093 −3.56 ± 23.38  

Values are presented as mean ± SD unless otherwise indicated.

GCIPL = ganglion cell-inner plexiform layer; ILM = internal limiting membrane; PVD = posterior vitreous detachment; IVGI = intravitreal gas injection.

* Paired t-test

Student's t-test

Mann-Whitney test; § Wilcoxon signed rank test.

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