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Kim and Lee: Analysis of the Maular Change in Optical Coherent Tomography after Internal Limiting Membrane Peeling
Original Article

J Korean Ophthalmol Soc 2008;49(2):253-260.

Published online: 31 August 2008

DOI: https://doi.org/10.3341/jkos.2008.49.2.253

Analysis of the Maular Change in Optical Coherent Tomography after Internal Limiting Membrane Peeling

Hyun-Jin Kim, M.D., Jeong-Hee Lee, M.D.

Department of Ophthalmology, School of Medicine, Ewha Womans University, Seoul, Korea

Address reprint requests to Jeong-Hee Lee, M.D., Department of Ophthalmology, Ewha Womans University College of Medicine, Mokdong Hospital #911-1 Mok-dong, Yangcheon-gu, Seoul 158-710, Korea Tel: 82-2-2650-5154, Fax: 82-2-2654-4334, E-mail: leejhoph@ewha.ac.kr

Received 16 May 2007       Accepted 31 October 2007

Copyright © 2008 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyse the postoperative anatomical changes of maculae using optical coherent tomography after internal limiting membrane peeling during vitrectomy.

Methods

A retrospective review of 22 patients (22 eyes) who underwent vitrectomy with internal limiting membrane peeling was performed. Age, sex, fundus findings, BCVA, operation methods, complications, and postoperative OCT findings were recorded.

Results

Of 22 eyes, 12 eyes had epiretinal membranes, 5 eyes had macular holes, and 5 eyes had diffuse diabetic macular edemas. Eighteen of 22 eyes underwent internal limiting membrane peeling using ICG, with 1 eye treated with triamcinolone and 3 eyes treated with nothing. The postoperative improvement of BCVA was statistically significant in epiretinal membrane and diffuse macular edema patients (p<0.05), but insignificant in macular hole patients (p>0.05). Postoperative OCT findings of 17 eyes showed that they had returned to normal shape and thickness. However, among the 18 eyes that underwent ICG dye-assisted ILM, 3 eyes showed irregular macular thinning and 1 eye showed macular cystic changes. One eye treated with triamcinolone presented with a recurrent cytoid macular edema. No postoperative complications or recurrences were reported by epiretinal membrane patients.

Conclusions

Changes to macular shape did not significantly affect the final BCVA after internal limiting membrane peeling, but they can cause changes to the microstructure of maculae. Therefore, caution during surgery and close follow-up are necessary.

Keywords: Internal limiting membrane peeling, Optical coherent tomography

References

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Figure 1.
(A) preoperative fundus photography; (B) preoperative fluorescien angiography; (C) peeled ILM, electromicroscopic finding X 150,000; (D) fundus photography at 1 year after operation; (E) OCT finding shows irregular surface and thinning of the macular area.
jkos-49-253f1.tif
Figure 2.
(A) preoperative fundus photography; (B) preoperative OCT finding; (C) peeled ILM, electromicroscopic finding X 20,000; (D) OCT finding at 1 day after operation; (E) fundus photograph at 6 month after operation; (F) OCT finding at 6 month after operation.
jkos-49-253f2.tif
Table 1.
Demographics of 5 patients with postoperative abnormal OCT change
Pt No. Age (yrs) Sex ILM stain Dx Gas tamponade DM Preop VA (logMAR) Postop VA (logMAR) OCT change
2Mo Final
1 60 F + ERM − Y 0.52 0.05 0.10 Macular thinning
2 73 F + MH C3 F8 Y 0.70 0.22 0.22 Macular thinning
3 62 F + MH C3 F8 Y 0.30 0.70 0.70 Macular thinning
4 54 F − (TA) ERM − N 0.30 0.15 0.10 CME
5 56 F + ERM − N 0.15 0.00 0.15 CME

ERM=epiretinal membrane; MH=macular hole; DME=diffuse macular edema; ICG=indocyanine green; TA, triamcinolone.

Table 2.
Comparison of log MAR(minimum angle of correction) best corrected visual acuity measured preoperatively and postopertively in each disease
Group Preoperative BCVA Postoperative BCVA * p-value
ERM (n=12) 0.37 0.14 0.01
MH (n=5) 0.99 0.67 0.22
DME (n=5) 0.68 0.44 0.04

ERM=epimacular edema; MH=macular edema; DME=diffuse macular edema

* p-value.

Table 3.
Comparison of postoperative BCVA between patients with normal and abnormal OCT findings
OCT finding
 * p-value
Normal Abnormal
0.36 0.22 0.59

* p-value.

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