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Balducci, Nicole MD*; Morara, Mariachiara MD; Veronese, Chiara MD; Torrazza, Carlo MD; Pichi, Francesco MD; Ciardella, Antonio P. MD

doi: 10.1097/IAE.0000000000000004
Original Study

Purpose: To identify early and late retinal nerve fiber layer thickness (RNFLT) modification after internal limiting membrane peeling for idiopathic macular hole or epiretinal membrane and to correlate RNFLT to visual field indices.

Methods: Single-center, prospective, interventional consecutive case series. Complete ophthalmic examination, fundus images, and spectral domain optical coherence tomography were performed in 30 eyes of 30 patients before and 1, 3, and 6 months after surgery. Six peripapillary sectors (superotemporal, temporal, inferotemporal, inferonasal, nasal, superonasal) and global RNFLT were evaluated. Visual field was performed preoperatively and 6 months postoperatively.

Results: Significant RNFLT modification was found after surgery (P < 0.0001). Specifically, RNFLT significantly increased in all, but the temporal sectors, 1 month after surgery, and it returned to preoperative values at the third month. Six months after surgery, RNFLT was lower than basal values in the superotemporal, inferotemporal, and temporal sectors (P < 0.001, P < 0.05, and P < 0.001, respectively) with an average reduction of 18.2 ± 9.8 µm. No correlation was found between RNFLT and the visual field indices.

Conclusion: The diffuse RNFLT increase 1 month postoperatively could be because of inflammatory responses. The reduction of RNFLT in the temporal sectors 6 months postoperatively could indicate damage to the macular retinal nerve fiber layer caused by internal limiting membrane peeling.

Significant changes occur in the peripapillary retinal nerve fiber layer thickness after internal limiting membrane peeling. In fact, after the first month, diffuse thickening, and thinning of the temporal, superotemporal, and inferotemporal sectors could be detected and could demonstrate damage in the arcuate nerve fiber layer related to surgery.

*Ophthalmology Unit, University of Bologna, Bologna, Italy;

Ophthalmology Unit, Sant’Orsola-Malpighi Hospital, Bologna, Italy; and

San Giuseppe Hospital, University Eye Clinic, Milan, Italy.

Reprint requests: Antonio P. Ciardella, MD, Sant’Orsola-Malpighi Hospital, Via Pelagio Palagi, 9, Bologna 40138, Italy; e-mail:

Paper presented in part at the Association for Research in Vision and Ophthalmology Annual Meeting, Fort Lauderdale, FL, May 2012 and it has been selected to receive a travel grant.

None of the authors have any financial/conflicting interests to disclose.

© 2014 by Ophthalmic Communications Society, Inc.