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The relationship between a dissociated optic nerve fibre layer appearance after macular hole surgery and Muller cell debris on peeled internal limiting membrane

Lookup NU author(s): Professor David SteelORCiD, Dr Kathryn White, Dr Peter Avery



This is the authors' accepted manuscript of an article that has been published in its final definitive form by John Wiley & Sons Ltd, 2017.

For re-use rights please refer to the publisher's terms and conditions.


© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons LtdPurpose: 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. Method: 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%. Conclusion: 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.

Publication metadata

Author(s): Steel DHW, Dinah C, White K, Avery PJ

Publication type: Article

Publication status: Published

Journal: Acta Ophthalmologica

Year: 2017

Volume: 95

Issue: 2

Pages: 153-157

Print publication date: 01/03/2017

Online publication date: 29/08/2016

Acceptance date: 18/06/2016

Date deposited: 11/09/2017

ISSN (print): 1755-375X

ISSN (electronic): 1755-3768

Publisher: John Wiley & Sons Ltd


DOI: 10.1111/aos.13195

PubMed id: 27572851


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