title: The relationship between a dissociated optic nerve fibre layer appearance after macular hole surgery and Muller cell debris on peeled internal limiting membrane.
abstract: OBJECTIVE
  A dissociated optic nerve fibre layer (DONFL) is a characteristic change noted in inner retinal morphology after internal limiting membrane (ILM) peeling. It is thought to be due to trauma to Muller cells as the ILM is peeled from their attached end plates. In this study, we aimed to determine the extent and size of Muller cell debris on the retinal side of excised ILM and assess whether this correlated with the extent of DONFL observed postoperatively.
  
  
  METHODS
  Prospective single centre study of a consecutive series of patients undergoing macular hole surgery. Transmission electron microscopy of the ILM was used to assess Muller cell debris and postoperative spectral domain optical coherence tomography (SD-OCT) to assess the extent of DONFL. A variety of other pre- and postoperative features was also included.
  
  
  RESULTS
  Thirty-nine patients were analysed. There were retinal dimples characteristic of DONFL detected on SD-OCT in all 39 eyes. The portion of the retinal side of the ILM specimen covered by cellular debris ranged from 12% to 49%, with a median of 28%. Using linear regression, the percentage of retinal debris, the size of the debris and the postoperative visual acuity were significantly positively associated with the DONFL score. The total R squared for the model was 63.9%.
  
  
  CONCLUSIONS
  The extent of DONFL observed postoperatively can be partly explained by the amount of retinal side cellular debris on the retinal side of the peeled ILM. Surgical strategies which minimize this material could reduce the extent of DONFL.
authors: Sunderland Eye Infirmary, Sunderland, UK.|Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK.
authors: David H W
authors: DH
authors: Steel
authors: Sunderland Eye Infirmary, Sunderland, UK.
authors: Christiana
authors: C
authors: Dinah
authors: EM Research Services, Newcastle University, Newcastle Upon Tyne, UK.
authors: Kathryn
authors: K
authors: White
authors: School of Mathematics and Statistics, Newcastle University, Newcastle Upon Tyne, UK.
authors: Peter J
authors: PJ
authors: Avery
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000601:surgery* / Q000648:ultrastructure; D063928:Ependymoglial Cells / Q000648:ultrastructure*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D009412:Nerve Fibers / Q000648:ultrastructure*; D009900:Optic Nerve / Q000648:ultrastructure*; D011184:Postoperative Period; D011446:Prospective Studies; D012167:Retinal Perforations / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
keywords: ILM peeling; Muller cell; dissociated optic nerve fibre layer; internal limiting membrane; macular hole