ILM Peeling Size and Postoperative Foveal Tissue Elongation in Macular Hole Surgery

Jae Hong Park; Hye Min Jeon; Hee Seong Yoon

doi:10.3341/jkos.2014.55.12.1860

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Park, Jeon, and Yoon: ILM Peeling Size and Postoperative Foveal Tissue Elongation in Macular Hole Surgery

Original Article

J Korean Ophthalmol Soc 2014;55(12):1860-1867.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.12.1860

ILM Peeling Size and Postoperative Foveal Tissue Elongation in Macular Hole Surgery

Jae Hong Park, MD, Hye Min Jeon, MD, Hee Seong Yoon, MD

Busan Sungmo Eye Hospital, Busan, Korea

Address reprint requests to Hee Seong Yoon, MD Busan Sungmo Eye Hospital, #409-1 Haeundae-ro, Haeundae-gu, Busan 612-823, Korea, Tel: 82-51-743-0775, Fax: 82-51-743-0776, E-mail: heesyoon@dreamwiz.com

Received 13 June 2014 Revised 7 October 2014 Accepted 17 November 2014

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 evaluate the relationship between the size of internal limiting membrane (ILM) peeling and the elongation of foveal tissue after macular hole (MH) surgery.

Methods

The medical records of 29 patients (29 eyes) who developed elongation of foveal tissue on spectral domain optical coherence tomography (OCT) after vitrectomy with ILM peeling and gas tamponade for idiopathic MH were retrospectively reviewed. These eyes were classified into 3 subgroups by the size of ILM peeling: group A (9 eyes), smaller than 2 disc diameter (DD); group B (12 eyes), larger than 2 DD and within the major temporal vascular arcade, and group C (8 eyes), till the edge of the major temporal vascular arcade. Inter-outer plexiform layer (OPL) distance, representing elongation of foveal tissue, was measured 1, 3, and 6-8 months (only 18 eyes) postoperatively. ‘Asymmetric elongation’ was defined as non-uniform elongation of the foveal tissue in certain directions.

Results

Horizontal/vertical inter-OPL distances 1 month postoperative, in descending order, were: group B, 436.58 ± 88.54 / 404.92 ± 78.55 µm; group A, 421.33 ± 109.97 / 404.14 ± 120.9 µm; and C group, 389.25 ± 48.75 / 400 ± 52.23 µm. Variations in the horizontal/vertical inter-OPL distance 3 months after MH surgery were: group B, 136.83 ± 65.64 / 103.92 ± 73.37 µm; group A, 88.11 ± 41.57 / 75.89 ± 53.18 µm; and group C, 140.25 ± 68.51 / 83.63 ± 56.62 µm. There were no significant differences in inter-OPL distance, variation in inter-OPL distance, or percent asymmetry in both horizontal and vertical directions among these groups.

Conclusions

Elongation of the foveal tissue and asymmetric elongation after MH surgery were not associated with the size of ILM peeling.

Keywords: Asymmetry, Elongation, ILM peeling, Macular hole surgery

References

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Figure 1.

Classification into 3 subgroups by the size of internal limiting membrane (ILM) peeling. (A) Group A, smaller than 2 DD; (B) group B, larger than 2 DD and within the major temporal vascular arcade, and (C) group C, till the edge of the major temporal vascular arcade.

Figure 2.

The spectral domain optical coherence tomography (SD-OCT) images of 61-year-old female patient representing postoperative elongation of foveal tissue. Note the inter-outer plexiform layer (OPL) distance had been increased over follow-up period. (A) Preoperative state (B) 1 month after macular hole surgery (C) 3 months (D) 6 months.

Figure 3.

The distance between the edge of outer plexiform layer (OPL) was defined as ‘inter-OPL distance’. The spectral domain optical coherence tomography (SD-OCT) images were taken 1, 3 months after surgery using the 1:1 μm setting. The distance from the center of the foveal cyst to the edge of nasal edge of OPL was defined as N. N = nasal length; T = temporal length.

Figure 4.

Scatter diagram of inter-outer plexiform layer (OPL) distance and percent asymmetry in each patient along with postoperative period. (A, B) Distribution of the horizontal inter-OPL distance and percent asymmetry. (C, D) Distribution of the vertical inter-OPL distance and percent asymmetry.

Table 1.

Patient baseline characteristics

	Group A	Group B	Group C	p-value^*
No. of eyes (patients)	9 (9)	12 (12)	8 (8)
Age (years)	63.75 ± 7.3	58.57 ± 5.44	59.29 ± 6.73	0.769
Sex (M:F)	2:7	6:6	1:7	0.174
Hole diameter (μm)	258.39 ± 97.46	261.67 ± 63.67	266.31 ± 106.13	0.980
BCVA (log MAR)	0.68 ± 0.29	0.6 ± 0.39	0.7 ± 0.3	0.560
Axial length (mm)	23.47 ± 0.92	23.46 ± 0.97	23.28 ± 0.53	0.885
Follow-up duration (months)	19.7 ± 11.81	10.72 ± 4.48	12.18 ± 6.04	0.137

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity.

^* Kruskal-Wallis test.

Table 2.

Postoperative inter-OPL distance among the groups

	Group A	Group B	Group C	p-value^*
Horizontal inter-OPL distance
PostOP 1M (μm)	421.33 ± 109.97	436.58 ± 88.54	389.25 ± 48.75	0.485
PostOP 3M (μm)	509.44 ± 108.98	573.42 ± 81.58	529.5 ± 61.93	0.195
Variations from 1M to 3M (μm)	88.11 ± 41.57	136.83 ± 65.64	140.25 ± 68.51	0.244
Vertical inter-OPL distance
PostOP 1M (μm)	404.14 ± 120.9	404.92 ± 78.55	400 ± 52.23	0.911
PostOP 3M (μm)	480 ± 111.98	508.83 ± 74.18	483.63 ± 70.09	0.537
Variations from 1M to 3M (μm)	75.89 ± 53.18	103.92 ± 73.37	83.63 ± 56.62	0.539

Values are presented as mean ± SD.

OPL = outer plexiform layer; PostOP = postoperative; M = month.

^* Kruskal-Wallis test.

Table 3.

Postoperative asymmetry of foveal tissue elongation among the groups

	Group A	Group B	Group C	p-value^*
Horizontal direction
PostOP 1M^†
Nasal length (μm)	217 ± 55.52	218.42 ± 46.69	192 ± 45.95	0.461
Temporal length (μm)	204.33 ± 75.8	218.17 ± 65.81	197.25 ± 39.88	0.779
Percent asymmetry (μm)	16.86 ± 11.01	11.04 ± 10.93	15.12 ± 8.34	0.321
PostOP 3M
Nasal length (μm)	256.56 ± 49.79	314.25 ± 64.88	270.25 ± 73.92	0.138
Temporal length (μm)	252.89 ± 97.26	259.17 ± 54.93	259.25 ± 67	0.874
Percent asymmetry (μm)	17.44 ± 16	13.84 ± 11.11	16.23 ± 16.9	0.750
Vertical direction
PostOP 1M
Inferior length (μm)	197.11 ± 65.63	203.42 ± 41.4	197.13 ± 37.27	0.925
Superior length (μm)	207 ± 59.87	201.5 ± 52	202.88 ± 37.26	0.899
Percent asymmetry (μm)	7.78 ± 3.96	11.07 ± 8.79	9.61 ± 7.83	0.543
PostOP 3M
Inferior length (μm)	233.44 ± 41.82	277.08 ± 49.34	232 ± 41.54	0.078
Superior length (μm)	246.56 ± 85.27	231.75 ± 44.45	251.63 ± 44.09	0.792
Percent asymmetry (μm)	9.27 ± 7.16	11.19 ± 9.47	8.71 ± 5.23	0.842

Values are presented as mean ± SD.

PostOP = postoperative; M = month.

^* Kruskal-Wallis test.

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