Abstract
Dissociated optic nerve fiber layer (DONFL) appearance is characterized by dimpling of the fundus when observed after vitrectomy with the internal limiting membrane (ILM) peeling in macular diseases. However, the cause of DONFL remains largely unknown. Optical coherence tomography (OCT) findings have indicated that the nerve fiber layer (NFL) and ganglion cells are likely to have been damaged in patients with DONFL appearance. Since DONFL appearance occurs at a certain postoperative period, it is unlikely to be retinal damage directly caused by ILM peeling because apoptosis occurs at a certain period after tissue damage and/or injury. However, it may be due to ILM peeling-induced apoptosis in the retinal tissue. Anoikis is a type of apoptosis that occurs in anchorage-dependent cells upon detachment of those cells from the surrounding extracellular matrix (i.e., the loss of cell anchorage). The anoikis-related proteins βA3/A1 crystallin and E-cadherin are reportedly expressed in retinal ganglion cells. Thus, we theorize that one possible cause of DONFL appearance is ILM peeling-induced anoikis in retinal ganglion cells.
Highlights
Dissociated optic nerve fiber layer (DONFL) appearance, a fundus finding first reported by Tadayoni et al [1] in 2001, is observed after vitrectomy with the internal limiting membrane (ILM) peeling in macular diseases, such as a macular hole (MH) and the epiretinal membrane (ERM), or for rhegmatogenous retinal detachment [2,3]
While DONFL appearance can be observed by ophthalmoscopy or color fundus phoWhile DONFL appearance can be observed by ophthalmoscopy or color fundus photography, more detailed graphic images can be obtained by infrared fundus photography tography, more detailed graphic images can be obtained by infrared fundus photography or optical coherence tomography (OCT)
“inner retinal dimpling” may be more appropriate. Their findings reportedly showed that DONFL appearance is the result of an interplay between the damage to Müller cells caused by ILM peeling and the healing processes, and not damage to the RNFL itself
Summary
Dissociated optic nerve fiber layer (DONFL) appearance, a fundus finding first reported by Tadayoni et al [1] in 2001, is observed after vitrectomy with the internal limiting membrane (ILM) peeling in macular diseases, such as a macular hole (MH) and the epiretinal membrane (ERM), or for rhegmatogenous retinal detachment [2,3]. DONFL appearance features arcuate striae color changes, which appear to be multilinear in shape, that are frequently observed in the macular nerve fiber layer (NFL) (Figure 1A,B). The dissociated optic nerve fiber layer (DONFL) appearance features arcuate striae changes, whichwhich appear to be multilinear shaped, that are frequently observed in the in macular nerve fiber color changes, appear to be multilinear shaped, that are frequently observed the macular nervelayer fiber((B), layerwhite ((B), arrowheads)
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