Our Summary

This research paper discusses a study conducted on the impact of a surgical procedure called internal limiting membrane peeling, which is used to treat a condition known as macular hole in the eye. Using a technique called Spectral domain optical coherence tomography, the researchers were able to examine the structure of different layers of the retina before and after surgery.

The study included 50 eyes and the results were analyzed 3 months after the operation. The key findings were that, on average, the central thickness of the retina was 201 microns after the surgery. They noticed an increase in thickness in the inner nuclear layer of the retina on the side of the fovea (center of vision), whereas on the other side, they observed a decrease in thickness, particularly in the ganglion cell layer.

The researchers observed that the external limiting membrane, inner segment outer segment junction, and cone outer segment tips zone were restored in 100%, 69%, and 17% of eyes, respectively. This surgery also significantly improved the patient’s best corrected visual acuity (clearness or sharpness of vision), with an average post-operative score of 0.7logMAR, equivalent to 6/30 on the Snellen’s chart (a chart used to measure visual acuity).

The study achieved a successful anatomical closure rate of 72%, meaning that in 72% of the cases, the macular hole was successfully closed.

However, the findings also suggest that the peeling of the internal limiting membrane could negatively affect the inner retinal structure, particularly the ganglion cell layer. This could potentially impact the functional outcome of the surgery, indicating a need to limit the peeling of the internal limiting membrane.

FAQs

  1. What is the main purpose of the study on retinal surgery?
  2. What were the main findings in terms of retinal thickening and thinning after surgery?
  3. What impact does peeling the internal limiting membrane have on the retinal architecture?

Doctor’s Tip

A helpful tip a doctor might tell a patient about retinal surgery is to follow postoperative instructions carefully, including avoiding strenuous activities and taking any prescribed medications as directed. It is also important to attend all follow-up appointments to monitor healing and ensure the best possible outcome.

Suitable For

Patients with macular holes or other vitreoretinal disorders are typically recommended retinal surgery, specifically internal limiting membrane peeling. This study found that internal limiting membrane peel can lead to significant changes in retinal architecture, particularly in the ganglion cell layer, which can impact functional outcomes of the surgery. It is important to avoid peeling the internal limiting membrane over a larger surface area to minimize these alterations and improve surgical outcomes.

Timeline

Before retinal surgery:

  • Patient undergoes preoperative consultation and evaluation to determine the need for surgery
  • Patient may undergo imaging tests such as optical coherence tomography (OCT) to assess the condition of the retina
  • Surgical plan is formulated, including the decision to perform internal limiting membrane peeling
  • Patient is prepared for surgery, including receiving instructions on preoperative care and anesthesia options

After retinal surgery:

  • Patient undergoes postoperative monitoring and follow-up appointments to assess healing and visual outcomes
  • Spectral domain OCT is used to analyze the retinal architecture postoperatively, with a focus on changes in individual retinal layers
  • Retinal thickening and thinning are observed in different regions around the fovea, with significant changes in inner retinal layers
  • Restoration of outer retinal layers such as the external limiting membrane, inner segment outer segment junction, and cone outer segment tips zone may be seen
  • Best corrected visual acuity improves significantly postoperatively, indicating a positive functional outcome
  • Anatomical closure rate of the macular hole is achieved in a majority of cases, further supporting the success of the surgery

Overall, the study highlights the importance of careful consideration of the extent of internal limiting membrane peeling during macular hole surgery, as it can have a significant impact on retinal architecture and functional outcomes.

What to Ask Your Doctor

  1. What is the purpose of internal limiting membrane peeling for macular hole surgery?
  2. What are the potential risks and complications associated with this surgery?
  3. How will my retinal architecture be affected by the internal limiting membrane peel?
  4. How will you assess the thickness of individual retinal layers before and after the surgery?
  5. What is the expected outcome in terms of central macular thickness and variation in retinal layer thickness?
  6. Will there be any changes in my visual acuity after the surgery?
  7. What is the success rate of this surgery in terms of anatomical closure of the macular hole?
  8. How long is the recovery period and what can I expect in terms of postoperative care?
  9. Are there any specific activities or precautions I should take during the recovery period to optimize the outcome of the surgery?
  10. Are there any alternative treatment options available for my condition?

Reference

Authors: Modi A, Giridhar A, Gopalakrishnan M. Journal: Retina. 2017 Feb;37(2):291-298. doi: 10.1097/IAE.0000000000001129. PMID: 27429381