Antonio Ciardella (Bologna, Italy)


To report a particular appearance of the fundus, occasionally seen after removal of the internal limiting membrane (ILM).


56 eyes of 56 consecutive patients with an epiretinal membrane and 38 eyes of 36 consecutive patients with idiopathic macular hole, who underwent pars plana vitrectomy and ILM peeling. All patients received a complete ophthalmic examination, infrared (IR) and autofluorescence (AF) photography, and SD-OCT preoperatively, at one week, and at one and three months post operatively. Vitrectomy and gas tamponade were performed with ILM peeling after staining with brilliant peel.

Effectiveness / Safety:

On IR and AF photographs, 13 (13.8%) of 94 eyes with ILM peeling exhibited the SANFL appearance one week to one month postoperatively. The SANFL appearance became more distinct during the first month after detection and disappeared after a mean period of two months. These features were best visualized by means of AF imaging, as three to five hypofluorescent striae originating from the optic nerve head, and running between the macula and the vascular arcades. SD-OCT scanning through the striae, indicated a swelling of the accurate nerve fiber layer. No significant differences were found in eyes with or without SAFL for mean age or pre and postoperative BCVA (>0.05 for all variables).

Take home message:

The SANFL is an early transient appearance, not affecting visual recovery, which may be due to the same mechanical damage to Müller cells as previously described in DONFL. DONFL however, are reported at three months, as permanent lesions, located within the macular area, and with a ‘dimple’ appearance rather than swelling, on OCT