Título / Title

DEVELOPMENT OF DISSOCIATED OPTIC NERVE FIBER LAYER (DONFL) AFTER EPIRETINAL MEMBRANE SURGERY

Introdução / Purpose

To report the case of a patient who developed DONFL after membrane peeling.

Material e Método / Methods

Interventional case report

Resultados / Results

Female, 66 years old, complained of low visual acuity (BAV) in the right eye (OD) for 1 year. Best corrected visual acuity (BCVA) of 20/100 in OD and 20/20 in left eye (OS). Anterior biomicroscopy: nuclear cataract 1+/4+. Fundoscopy of OD: Arteriolar narrowing, epiretinal fibrotic tissue temporal to the fovea with internal limiting membrane (ILM) pleating, foveal continuity lesion and applied retina. Optical coherence tomography (OCT) demonstrated a grade IV epiretinal membrane (ERM). Phacoemulsification with LIO associated with vitrectomy with ERM peeling and ILM SF6 gas infusion was performed. 4 months after surgery, she presented BCVA of 20/50 in OD. 2 months later, she presented BCVA of 20/100 and altered macular brightness at fundoscopy. Structural OCT, showed hyporeflective spaces - appearance of cavitations in foveal temporal region along the neurosensory retina and center of the fovea. Facial OCT evidenced the presence of DONFL. An expectant approach was adopted. In the tenth postoperative month, the BCVA was 20/50, with a smaller DONFL area and a better aspect

Discussão e Conclusões / Conclusion

Tadayoni et al. noticed a new pattern of finding in the retina of patients undergoing internal limiting membrane peeling, characterized by arched streaks slightly darker than the surrounding retina, along the course of the optic nerve fibers, the DONFL. The postoperative incidence of this characteristic feature is approximately 42% to 62% and it does not seem to have a functional effect noticeable by the patient. There is still no consensus on the physiology of the appearance of DONFL, most hypotheses suggest that it is due to trauma during surgical procedure. Runckle et al. showed that a smaller retinal thickness was also correlated. These features are compatible with the exposed case, including a good final visual prognosis.

Palavras Chave

Epiretinal Membrane, Vitreoretinal Surgery, Fovea Centralis.

Area

SURGICAL RETINA