LAUSR

PURPOSE To describe schisis of the retinal nerve fiber layer (sRNFL) associated with epiretinal membranes (ERMs) seen on spectral domain optical coherence tomography (SD-OCT) prior to vitreoretinal surgery. Areas of sRNFL (size and location) were noted during preoperative planning. SD-OCT scans were obtained to study the inner retinal morphology postoperatively. DESIGN Retrospective observational consecutive case-series. METHODS Pre- and post-operative SD-OCT and en-face images of 41 eyes with ERMs that had undergone vitrectomy by a single surgeon were analyzed to record the presence of sRNFL. The extent of sRNFL was classified as focal or diffuse. Other characteristics such as involvement of the papillomacular bundle and areas of fibrillary protrusion of sRNFL above the ILM were documented. Color fundus photographs were reviewed to correlate with the SD-OCT images. RESULTS Mean patient age and length of follow-up were 69.3 years (range 52-82 years) and 6.8 months (range 0.25-21 months), respectively. Mean pre-operative and post-operative central thicknesses were 477μm and 387μm, respectively (p<0.0001). sRNFL was observed in 51.2% (21/41 eyes), and was classified as diffuse (>1 disc diameter) in 90.5% (19/21 eyes). Protrusion of sRNFL through the ILM was present in 76.2% (16/21 eyes) and occurred in areas of dehiscence of the adjacent internal limiting membrane (ILM). sRNFL was best visualized on SD-OCT and en-face imaging at the vitreoretinal interface (VRI) and sometimes correlated with areas of retinal whitening. sRNFL resolved in all cases post-operatively. CONCLUSIONS sRNFL was a relatively common occurrence in ERMs, correlated frequently with areas of dehisced ILM intra-operatively, and resolved post-operatively in all cases.