Three-Dimensional Quantitative Analysis of Internal Limiting Membrane Peeling Related Structural Changes in Retinal Detachment Repair

Tzu-Han Hsieh; Jia-Kang Wang; Fang-Ting Chen; Yun-Ju Chen; Ling-Uei Wang; Tzu-Lun Huang; Pei-Yao Chang; Yung-Ray Hsu

doi:10.1016/j.ajo.2024.08.022

Three-Dimensional Quantitative Analysis of Internal Limiting Membrane Peeling Related Structural Changes in Retinal Detachment Repair

Am J Ophthalmol. 2025 Jan:269:94-104. doi: 10.1016/j.ajo.2024.08.022. Epub 2024 Aug 24.

Authors

Tzu-Han Hsieh¹, Jia-Kang Wang², Fang-Ting Chen³, Yun-Ju Chen³, Ling-Uei Wang¹, Tzu-Lun Huang⁴, Pei-Yao Chang³, Yung-Ray Hsu⁵

Affiliations

¹ From the Department of Ophthalmology (T-H.H., J-K.W., F-T.C., Y-J.C., L-U.W., T-L.H., P-Y.C., Y-R.H.), Far Eastern Memorial Hospital, New Taipei City, Taiwan.
² From the Department of Ophthalmology (T-H.H., J-K.W., F-T.C., Y-J.C., L-U.W., T-L.H., P-Y.C., Y-R.H.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Ophthalmology (J-K.W., F-T.C., Y-J.C., P-Y.C., Y-R.H.), National Taiwan University Hospital, Taipei, Taiwan; Department of Electrical Engineering (J-K.W., T-L.H., Y-R.H.), Yuan Ze University, Taoyuan, Taiwan.
³ From the Department of Ophthalmology (T-H.H., J-K.W., F-T.C., Y-J.C., L-U.W., T-L.H., P-Y.C., Y-R.H.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Ophthalmology (J-K.W., F-T.C., Y-J.C., P-Y.C., Y-R.H.), National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University College of Medicine (F-T.C., Y-J.C., P-Y.C., Y-R.H.), Taipei, Taiwan.
⁴ From the Department of Ophthalmology (T-H.H., J-K.W., F-T.C., Y-J.C., L-U.W., T-L.H., P-Y.C., Y-R.H.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Electrical Engineering (J-K.W., T-L.H., Y-R.H.), Yuan Ze University, Taoyuan, Taiwan.
⁵ From the Department of Ophthalmology (T-H.H., J-K.W., F-T.C., Y-J.C., L-U.W., T-L.H., P-Y.C., Y-R.H.), Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Ophthalmology (J-K.W., F-T.C., Y-J.C., P-Y.C., Y-R.H.), National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University College of Medicine (F-T.C., Y-J.C., P-Y.C., Y-R.H.), Taipei, Taiwan; Department of Electrical Engineering (J-K.W., T-L.H., Y-R.H.), Yuan Ze University, Taoyuan, Taiwan. Electronic address: yungrayhsu@gmail.com.

PMID: 39187230
DOI: 10.1016/j.ajo.2024.08.022

Abstract

Purpose: To assess macular microstructural changes associated with internal limiting membrane peeling (ILMP) using 3-dimensional optical coherence tomography (3D-OCT) in primary macula-off rhegmatogenous retinal detachment (RRD) repairs with vitrectomy and silicone oil (SO) tamponade.

Design: Retrospective, consecutive, interventional case series.

Methods: Setting: Institutional practice.

Patient population: Patients who received primary RRD repair by a single experienced surgeon between January 2017 and December 2021.

Main outcome measures: In the qualitative comparative analysis, the presence of macular changes among patients who underwent primary RRD repair with (21 eyes) or without ILMP (20 eyes) were observed. Subsequently, a detailed quantitative analysis of ILMP-related microstructural changes in 56 eyes using both 3D and 2D-OCT images were performed.

Results: In the qualitative comparative analysis, macular microstructural changes were observed in 95% of ILMP eyes and 5% of non-ILMP eyes (p < .001). In the quantitative analysis, 4 major macular microstructural changes were detected: dimple (75%), dissociated nerve fiber layer (DONFL) (55%), ILM peeling edge thinning (IPET) (64%), and temporal macular groove (TMG) (23%). Dimples (n = 251, average 4.5 ± 5.8 per eye) could be further classified into type I (confined to the inner plexiform layer [IPL]; 73%) and type II (beyond IPL, 27%). The average depth of the deepest dimples was 58 ± 18 µm. The extent of IPET was 6.0 ± 3.7 clock hours. The average length of TMG was 1.8 ± 0.4 mm. Comparing to unoperated fellow eyes, the eyes after ILMP showed decreased inner temporal over nasal retinal thickness ratio (0.86 ± 0.07 versus 0.96 ± 0.03, p < .001), shorter disc-fovea distance (4.61 ± 0.32 µm versus 4.78 ± 0.37 µm, p = .041), and wider retinal vein trajectories (c' = 2.48 ± 0.84 vs 3.39 ± 1.61, p = .002).

Conclusions: Macular microstructural changes are common after ILMP in RRD repair, encompassing both focal changes (dimples, DONFL) and zonal changes (IPET, TMG). DONFL and dimples may be part of a continuum of findings stemming from the same mechanism. IPET and TMG are the results of macular tissue shift due to contracture of the optic disc and neurovascular bundle.

MeSH terms

Adult
Aged
Basement Membrane* / surgery
Endotamponade*
Epiretinal Membrane / diagnosis
Epiretinal Membrane / physiopathology
Epiretinal Membrane / surgery
Female
Humans
Imaging, Three-Dimensional*
Macula Lutea / diagnostic imaging
Macula Lutea / pathology
Male
Middle Aged
Nerve Fibers / pathology
Retinal Detachment* / diagnosis
Retinal Detachment* / surgery
Retrospective Studies
Silicone Oils / administration & dosage
Tomography, Optical Coherence* / methods
Visual Acuity* / physiology
Vitrectomy*

Substances

Silicone Oils