Comparisons of Retinal Nerve Fiber Layer Thickness after Indocyanine Green, Brilliant Blue G, or Triamcinolone Acetonide-Assisted Macular Hole Surgery

Abstract

Purpose. To compare the postoperative changes of the retinal nerve fiber layer (RNFL) thickness in patients with macular holes (MHs) treated with vitrectomy with indocyanine green- (ICG-), brilliant blue G- (BBG-), or triamcinolone acetonide- (TA-)assisted internal limiting membrane (ILM) peeling. Methods. Sixty-one eyes of 61 consecutive patients with MHs were studied. Each eye was randomly selected to undergo either ICG- (n = 18), BBG- (n = 21), or TA-assisted (n = 22) ILM peeling. The circumferential retinal nerve fiber layer (RNFL) thickness was determined by spectral-domain optical coherence tomography (SD-OCT) before and 1, 3, 6, 9, and 12 months postoperatively. The mean overall and the sectoral thicknesses of the RNFL were obtained for each group. Results. A transient increase of the RNFL thickness was seen in the mean overall and sectoral thicknesses except for the nasal/inferior sector at 1 month after surgery for the three groups. Then, the thickness gradually decreased and returned to the baseline level in all sectors except for the nasal/inferior sector. The differences in the RNFL thickness among the groups were not significant for at least 12 months postoperatively. Conclusions. The degree of change of the RNFL thickness was not significantly related to the type of vital stain used during MH surgery.

Changes in Inner and Outer Retinal Layer Thicknesses after Vitrectomy for Idiopathic Macular Hole: Implications for Visual Prognosis

“…Surprisingly, in contrast to the GCL-IPL layer thinning after surgery, the most superficial (ILM-NFL) layer thickness did not show any significant changes during follow-up in our cases applied with BBG. This is supported by and consistent with recently published data showing that BBG-assisted MH surgeries eventually maintained the baseline level of NFL thickness [ 20 ]. More importantly, the degree of GCL-IPL thinning currently observed, approximately 10 μm, is equivalent to that of the NFL-IPL thinning after MH surgery assisted by BBG [ 21 ].…”

“…More importantly, the degree of GCL-IPL thinning currently observed, approximately 10 μm, is equivalent to that of the NFL-IPL thinning after MH surgery assisted by BBG [ 21 ]. These recent analyses on inner retinal layers [ 20 , 21 ] further validate our measurements. Thus, retinal mechanical and cytotoxic damage as a consequence of ILM removal is likely to be minimal or negligible.…”

Transient Increase of Retinal Nerve Fiber Layer Thickness after Vitrectomy with ILM Peeling for Idiopathic Macular Hole

“…They found no significant decrease in temporal sector after MH surgery. Instead, an increase in the RNFL thickness in the nasal quadrant or a decrease in the nasal-inferior sector was observed [ 14 , 15 ].…”

“…The second possible reason for the discrepancy is the differences in the SD-OCT instruments used. In recent studies, the SD-OCT instruments used for RNFL thickness measurements were the Cirrus OCT (Carl Zeiss Medlitec, Dublin, CA) [ 14 , 17 , 18 ] or Spectralis HRA + OCT [ 15 , 16 ]. The reproducibility of the RNFL thickness measurements with the Spectralis SD-OCT with the eye tracking system is excellent for the follow-up measurements [ 28 , 29 ].…”

“…Toba et al measured the RNFL thickness by the same type of SD-OCT instrument, the Spectralis HRA + OCT, as we did [ 15 ]. The surgical procedures were also similar to our procedures.…”