Zeitschrift für klinische und experimentelle Ophthalmologie
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Transient OCT Highly Reflective Layer Following Macular Hole Surgery

Paul G Rainsbury, Emily Gosse and Jonathan Lochhead

Objective: Internal Limiting Membrane (ILM) peeling during macular hole surgery is commonly performed. In spite of this, little is known about the exact histological effect that this has on the retina post-operatively, due to a lack of clinicopathological studies.
OCT imaging is increasing our understanding of structural changes that occur after macular hole surgery, and is now widely used. Recently OCT observations have included Concentric Macular Dark Spots (CMDS) and Swelling of the Arcuate Nerve Fibre Layer (SANFL). In this paper a new postoperative OCT observation is described. This occurs transiently after macular hole surgery. The observation consists of a Highly Reflective Layer (HRL) on the retinal surface, and has been observed 1 month after surgery following gas disappearance.
Methods: A retrospective review of 26 consecutive cases of stage II-IV macular holes treated with 3 port pars plana vitrectomy, ILM peel and gas tamponade.
Results: HRL was found to be present in 31% of cases, and appears to be related to increased central retinal thickness pre-operatively and at 1 month postoperatively. HRL appears less likely in cases in which Triamcinolone Acetonide was used for assisted induction of posterior vitreous detachment, and more likely in combined phacoemulsification vitrectomy procedures. HRL did not appear to influence macular hole closure rates or visual acuity improvement.
Conclusion: The aetiology of this transient HRL on the surface of the retina is unclear, but it may represent a transient fibrinous process caused by the release of inflammatory mediators during ILM peeling.