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Bare retinal nerve fiber layer and internal limiting membrane tear associated with epiretinal membrane: OCT findings and visual outcomes

  • Retinal Disorders
  • Published:
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Abstract

Purpose

This study aims to describe spectral-domain optical coherence tomography (OCT) characteristics and assess surgical outcomes for bare retinal nerve fiber layer (RNFL) and internal limiting membrane (ILM) tear associated with the epiretinal membrane (ERM).

Methods

This retrospective study comprised 158 consecutive patients with idiopathic ERM with (group A) or without (group B) bare RNFL (19 and 139 patients, respectively) who underwent vitrectomy between March 2016 and May 2019. Surgical videos and pre- and postoperative OCT images were reviewed to characterize bare RNFL and ILM tear and analyze postoperative visual outcomes.

Results

Typically, the torn ILM is seen as a mono- or multi-layered thin scrolled membrane in OCT, correlated frequently with areas of RNFL schisis. On the near-infrared fundus images, a hypo-reflective band corresponding to rolled-up edge of torn ILM and ERM was identified. The bare RNFL area was located adjacent to and peripheral to this band and showed a less-wrinkled retina preoperatively. Mean logMAR BCVA and central foveal thickness (CFT) progressively improved in both groups. However, group A had greater mean CFT change than group B (P = 0.001).

Conclusion

Typical appearances of bare RNFL and ILM tear associated with ERM were identified. Thorough evaluation of preoperative OCT is important for vitreoretinal surgeons to recognize bare RNFL and ILM tear to minimize surgical trauma.

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Availability of data and material

The data used to support the findings of this study are available from the corresponding author upon request.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil Songpa-gu, Seoul, 05505, Republic of Korea

    Joon Hyung Yeo & June-Gone Kim

Authors
  1. Joon Hyung Yeo
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  2. June-Gone Kim
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Corresponding author

Correspondence to June-Gone Kim.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Institutional Review Board of the Asan Medical Center (IRB No. 2019-1066) and adhered to the tenets of the Declaration of Helsinki. Due to the retrospective study design and use of de-identified patient data, the need for obtaining written informed consent was waived.

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Electronic supplementary material

Representative example of bare retinal nerve fiber layer (RNFL) and internal limiting membrane (ILM) tear associated with the epiretinal membrane. After staining the posterior pole with 0.25% indocyanine green, unstained area of the ILM, suggesting a bare RNFL, was observed.

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Yeo, J.H., Kim, JG. Bare retinal nerve fiber layer and internal limiting membrane tear associated with epiretinal membrane: OCT findings and visual outcomes. Graefes Arch Clin Exp Ophthalmol 258, 1379–1387 (2020). https://doi.org/10.1007/s00417-020-04684-x

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  • DOI: https://doi.org/10.1007/s00417-020-04684-x

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