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Kim, Lee, Lee, and Oum: Visual Field Defect Developed after Internal Limiting Membrane Peeling in a Patient with Epiretinal Membrane
Case Report
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2011; 52(3): 378-384.

Published online: 31 March 2011

DOI: https://doi.org/10.3341/jkos.2011.52.3.378

Visual Field Defect Developed after Internal Limiting Membrane Peeling in a Patient with Epiretinal Membrane

Kyong Ho Kim, MD, Ji Woong Lee, MD, Ji Eun Lee, MD, PhD, Boo Sup Oum, MD, PhD

Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea.

Address reprint requests to Ji Woong Lee, MD. Department of Ophthalmology, Pusan National University Hospital, #1-10 Ami-dong, Seo-gu, Busan 602-739, Korea. Tel: 82-51-240-7326, Fax: 82-51-242-7341, alertlee@hanmail.net

Received 23 July 2010       Accepted 16 December 2010

Copyright © 2011 The Korean Ophthalmological Society

Abstract

Purpose

To report a case of visual field defect developed after internal limiting membrane (ILM) peeling in a patient with macular epiretinal membrane (ERM).

Case summary

A 33-year-old female without a history of specific diseases presented with a gradually decreased visual acuity in the right eye for 3 years. The patient was diagnosed as having macular ERM and underwent vitrectomy. During ILM peeling, retinal hemorrhage occurred in the superior region of macula, which spontaneously disappeared 2 weeks after surgery. Transmission electron microscopy showed Müller cell end feet with damaged appearance adherent to the ILM. At 3 months after surgery, the patient developed retinal nerve fiber layer (RNFL) defect in the area where the spot retinal hemorrhage had occurred. Optical coherence tomography showed focal RNFL thinning in the superotemporal region. The automated perimetry revealed corresponding inferior nasal step and scotomas in the right eye. Intraocular pressure was normal throughout the follow-up period and there was no evidence of glaucomatous optic disc change.

Conclusions

The results obtained from the patient in the present study indicated that visual field defect may be the result of a mechanical damage to the RNFL during ILM peeling.

Keywords: Internal limiting membrane peeling, Retinal nerve fiber layer defect, Visual field defect

Figures and Tables

Figure 1
(A) The preoperative fundus photograph shows opaque and gray proliferative membranes on the surface of the macula. (B) The preoperative OCT image shows epiretinal membrane with multifocal points of attachment to the macular region and abnormal areas of hyporeflectivity in the outer retinal layer.
jkos-52-378-g001
Figure 2
(A) The fundus photograph at postoperative 1 day. Below the superior vascular arcade, retinal hemorrhages (black arrow) are noted and no epiretinal membrane was observed at the macular region. (B) Transmission electron microscopy shows Müller cell end feet (asterisk) with damaged appearance adherent to the internal limiting membrane (ILM) (×6,000).
jkos-52-378-g002
Figure 3
The color fundus photograph, RNFL photograph, OCT and visual field at postoperative 3 months. Color fundus photograph (A) and RNFL photograph (B) show RNFL defect at the previous retinal hemorrhage site (white arrows). However, there is no glaucomatous optic disc change. OCT shows focal RNFL thinning in superotemporal region (black arrow) in TSNIT graph (C), which is consistent with RNFL thickness deviation map (D). Automated perimetry shows nasal step and inferior scotoma in gray scale (E) and pattern deviation (F).
jkos-52-378-g003

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