OSLI Retina

July 2019

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414 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C L I N I C A L S C I E N C E ■ Displacement of the Foveal Retinal Layers After Macular Hole Surgery Assessed Using En Face Optical Coherence Tomography Images Seung Min Lee, MD; Keun Heung Park, MD; Han Jo Kwon, MD; Sung Who Park, MD; Ik Soo Byon, MD, PhD; Ji Eun Lee, MD, PhD BACKGROUND AND OBJECTIVE: To investigate the dis- placement of foveal retinal layers in surgically closed macular holes (MHs) after removal of the internal limiting membrane (ILM). PATIENTS AND METHODS: Medical records of 26 con- secutive patients who underwent vitrectomy and removal of the ILM for idiopathic MH were retro- spectively reviewed. En face optical coherence to- mography images were exported at the level of the choroid, ellipsoid zone (EZ), and inner plexiform layer (IPL) at baseline and at 1, 3, and 6 months. The foveal center of the EZ and IPL was marked in the choroid en face image. The choroidal images were overlapped to match the vasculature in each patient, and the postoperative displacement of the foveal cen- ter was compared to baseline. RESULTS: The center of the EZ and IPL was dis- placed significantly toward the disc during the first 3 months. The mean horizontal displacement at 1, 3, and 6 months was 52.7 µm, 112.5 µm, and 115.4 µm, respectively, for the EZ and 75.2 µm, 117.1 µm, and 136.5 µm, respectively, for the IPL. The location of the foveal center was significantly correlated between the EZ and the IPL (P ≤ .016). CONCLUSIONS: The fovea was displaced nasally and slightly inferiorly after removal of the ILM. The dis- placement of the photoreceptor and inner retinal lay- ers was concurrent. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:414-422.] INTRODUCTION Vitrectomy combined with various manipulations of the internal limiting membrane (ILM) such as ILM peeling, inverted flap, and autologous flap results in successful closure of the macular hole (MH) in almost all cases. 1-4 However, functional recovery is less sat- isfactory compared to the anatomical success rate. 5,6 Postoperative metamorphopsia particularly remains an unresolved complication. 7 Recently, it was reported that the removal of the ILM induced macular deformation. 8 Importantly, the extent of the removal was associated with the degree of metamorphopsia. 9 However, debates remain re- garding the mechanisms of the macular deformation and metamorphopsia. 8,9 This may be due to that most studies investigating postoperative deformation were based on the inner retina, since the assessment of the outer retina is less feasible due to the lack of land- marks. Those results could not provide information regarding the photoreceptor layer and fovea, which are more directly related to visual function. The progress of enhanced depth imaging and swept-source optical coherence tomography (SS- OCT) enabled visualization of the choroidal vessels in en face images. The choroidal vessels provide a ref- erence for postoperative displacement of the fovea, as MH surgery would not deform the choroid. Herein, we investigated the postoperative dis- placement of the foveal retinal layers using en face OCT images after MH surgical closure. PATIENTS AND METHODS Study Subjects This study was a retrospective, interventional case series. We included idiopathic patients with MH who From the Department of Ophthalmology, College of Medicine, Pusan National University, Yangsan, Korea (SWP, ISB, JEL); Research Institute for Conver- gence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea (SML, ISB); and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea (KHP, HJK, SWP, JEL). Originally submitted July 13, 2018. Revision received October 11, 2018. Accepted for publication January 17, 2019. The authors report no relevant financial disclosures. Address correspondence to Ji Eun Lee, MD, PhD, Department of Ophthalmology, Pusan National University Hospital, 179 Guduk-Ro, Seo-gu, Busan, South Korea 49241; email: jlee@pusan.ac.kr. doi: 10.3928/23258160-20190703-02

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