|Year : 2021 | Volume
| Issue : 2 | Page : 208-209
Rushik Patel, Kushal Delhiwala, Bakulesh Khamar
Department of Vitreo Retina, Netralaya Superspeciality Eye Hospital, Ahmedabad, Gujarat, India
|Date of Submission||05-Oct-2020|
|Date of Acceptance||17-Dec-2020|
|Date of Web Publication||01-Apr-2021|
Dr. Kushal Delhiwala
Netralaya Superspeciality Eye Hospital, KD House, 1st Floor, Above Andhra Bank, Parimal Cross Roads, Ellisbridge, Ahmedabad - 380006, Gujarat
Source of Support: None, Conflict of Interest: None
Keywords: Decellularized scaffold, dissociated optic nerve fiber layer, en-face SSOCT, inner retinal dimples
|How to cite this article:|
Patel R, Delhiwala K, Khamar B. Poriferous macula. Indian J Ophthalmol Case Rep 2021;1:208-9
| Case Report|| |
A 62-year-old pseudophakic female having right eye full-thickness macular hole and vitreomacular traction [Figure 1]a and [Figure 1]b; underwent vitrectomy with conventional internal limiting membrane (ILM) peeling and 20% sulfur hexafluoride (SF6) gas tamponade. At 6-weeks follow-up, visual acuity improved from 20/120 to 20/40. Fundus evaluation revealed a closed macular hole and dark arcuate striae in the area of peeled ILM, corresponding to dissociated optic nerve fiber layer (DONFL) appearance [Figure 2]a. The horizontal B scan swept-source optical coherence tomography (SS-OCT- Triton plus-Topcon, Tokyo, Japan) showed type 1 closure with foveal lucency and inner retinal dimples of variable depths in para- and perifoveal region [Figure 2]b. These retinal dimples were deeper and wider, temporal to fovea in comparison with nasal to fovea (papillomacular bundle). En face SS-OCT image at the ILM layer showed multiple spindle-shaped defects concentric to the fovea and wider temporally corresponding to dimples [Figure 2]c. Such appearance resembles decellularized scaffolds which are poriferous in nature.
|Figure 1: (a) Preoperative fundus photo of the right eye showing a full-thickness macular hole (white arrow). (b) B scan swept-source optical coherence tomography (SS-OCT) image showing full-thickness macular hole and vitreomacular traction (white arrow)|
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|Figure 2: (a) Postoperative fundus photo showing closed macular hole and dark arcuate striations superior, inferior, and temporal to fovea (white arrows) suggestive of dissociated optic nerve fiber layer (DONFL). (b) B scan SS-OCT image through fovea showing type 1 hole closure, foveal lucency (white arrowhead), and inner retinal dimples (white arrows), more prominent temporal to the fovea than over papillomacular bundle. (c) Postoperative en face SS-OCT image at ILM layer shows multiple spindle-shaped defects concentric to the fovea and wider temporally, corresponding to dimples, giving the poriferous appearance to the macula|
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| Discussion|| |
The poriferous appearance of decellularized scaffold is due to the retained extracellular matrix (ECM) in biological materials following removal of cellular components. Poriferous appearance is also described in sponge, decayed wood as well as biodegradable hydrogel. It is plausible that inner retinal cells adherent to ILM (Muller cells and ganglion cells) are removed along with ILM. The loss of cells in the area of ILM peeling may be responsible for poriferous appearance mimicking decellularized scaffold. Another plausible cause could be changes in the retinal nerve fiber layer (RNFL) following ILM peeling. This is least likely as the pattern does not follow the horizontal raphe of RNFL. Similar macular changes following ILM peeling are also described as concentric macular dark spots (CMDS).
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]