To investigate the incidence and risk factors of dissociated optic nerve fiber layer(DONFL) after epiretinal membrane surgery (ERM).


A total of 296 pars plana vitrectomy (PPV) operations were included in the study and the study period was between July, 2009 and January, 2013. 30 consecutive eyes of 30 patients developed DONFL after primary PPV for ERM. Univariate and multivariate analysis were performed to establish the risk factors.


The median age of the patients with DONFL was 63.62 years. The overall frequency of DONFL was 10.1%. The mean time from ERM surgery to the DOFNL formation was 5.0 months. Internal limiting membrane (ILM) peeling was performed in 29 out of 30 (96.7%) eyes of DONFL group compared with 126 out of 266 (47.4%) eyes of control group (p<0.001). Intravitreal gas tamponade was performed in 21 eyes (70.0%) of DONFL group compared with 133 eyes (50.0%) of control group(p=0.038). ILM peeling (OR: 32.22 [4.33,240.0], p=0.001) and intravitreal gas tamponade (OR: 2.33 [1.03,5.28], p=0.042) were significantly associated with the formation of DONFL.


We found 10.1% incidence of DONFL formation after ERM surgery. ILM peeling and intravitreal gas tamponade were strongly correlated with postoperative DONFL formation. Compared to ILM peeling alone, ILM peeling with intravitreal gas tamponade had stronger correlation with postoperative DONFL formation.

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Sung Jin Lee