This 75YO male underwent successful macular hole surgery 5 years earlier. Vision was 20/40.
Color photography shows scattered mixed drusen. B-scan OCT shows small irregular defects in the inner temporal macula. En face OCT shows extensive dimpling that parallels the nerve fiber layer.
Learning Points:
Pars plana vitrectomy with membrane peeling is frequently performed for the management of many vitreomacular interface disorders, including vitreomacular traction, macular hole, and epiretinal membrane.
While ILM peeling decreases epiretinal membrane recurrence and enhances macular hole closure, it also causes mechanical trauma to the inner retina, as evidenced by dissociated optic nerve fiber layer.
Many mechanisms have been proposed, including Müller cell damage from direct contact with surgical instruments, damage to the deep inner retinal layers, damage from visualization dye, or tractional thinning of the temporal retina.
