Intraoperative Microscope-Mounted Spectral Domain Optical Coherence Tomography for Evaluation of Retinal Anatomy during Macular Surgery

doi:10.1016/j.ophtha.2011.04.012

Ophthalmology

Volume 118, Issue 11, November 2011, Pages 2212-2217

Presented at: the Association for Research in Vision and Ophthalmology Annual Meeting, May, 2010.

https://doi.org/10.1016/j.ophtha.2011.04.012 Get rights and content

Objective

To evaluate the use of microscope mounted spectral domain optical coherence tomography (SD-OCT) to detect changes in retinal anatomy during macular surgery.

Design

Retrospective, observational case series.

Participants

We included 25 eyes of 24 consecutive patients who underwent SD-OCT during macular surgery.

Methods

A retrospective review of operative techniques, outcomes, and imaging for all patients who underwent intraoperative microscope mounted SD-OCT during surgery for macular hole or epiretinal membrane (ERM) from April 2009 to April 2010 was performed. Qualitative and quantitative characteristics of intraoperative and postoperative changes in retinal anatomy were studied.

Main Outcome Measures

Intraoperative change in macular hole dimensions and retinal thickness in patients with ERM owing to surgical manipulation measured using SD-OCT.

Results

Intraoperative SD-OCT from 13 eyes of 13 patients undergoing surgery for macular hole was reviewed. Two cases had images of suboptimal quality and were excluded. The remaining 11 eyes were subjected to quantitative analysis, which revealed stability of macular hole height and central hole diameter after internal limiting membrane (ILM) peeling, but an increase in the diameter of subretinal fluid under the macula in ten of 11 eyes (average 87% wider). Intraoperative imaging from 12 eyes of 11 patients undergoing surgery for ERM was analyzed. Quantitative analysis revealed an average increase of retinal thickness after ILM peel of <2%. Ten of 12 eyes developed a new subretinal hyporeflectance, which likely represents shallow detachment of the macula, after uncomplicated membrane peel.

Conclusions

Use of intraoperative SD-OCT has provided new insight into the changes to retinal anatomy during macular surgery and may prove to be a useful tool for vitreoretinal surgery. Further study is warranted to determine whether intraoperative changes such as the creation of shallow retinal detachments during uncomplicated macular surgery affects visual recovery.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Methods

A retrospective study of all patients undergoing macular hole or ERM surgery with concurrent intraoperative SD-OCT images was conducted. The Institutional Review Board of Emory University approved the study with a waiver of patient consent owing to the retrospective nature of the research. Imaging records were reviewed for all patients who underwent macular hole or ERM surgery with intraoperative imaging from April 2009 through April 2010 by 3 surgeons (S.S., B.H., and C.B.). Those who

Macular Hole Imaging

Thirteen eyes of 13 patients who underwent pars plana vitrectomy for macular hole and had intraoperative SD-OCT were identified. In 2 of the 13 eyes, the image quality obtained by the SD-OCT intraoperatively was insufficient for evaluation. Eleven eyes with high-quality imaging were reviewed. Pre- and postoperative information for the patients is listed in Table 1 (available online at http://aaojournal.org). Six of the eyes underwent 20-gauge vitrectomy and 5 underwent small-gauge surgery.

Discussion

Many studies have described the clinical application of OCT and how it has revolutionized vitreoretinal practice. Spectral domain OCT has provided greater resolution of retinal anatomy and provided previously unknown pathologic changes that are correlated to visual prognosis.2, 3, 4, 5, 6, 7, 11, 12 In this study, we have described a new way to use this technology in an operative setting and report several new findings that provide greater insight into the changes in retinal anatomy created

Acknowledgment

The authors acknowledge R.J. Minton for design and construction of the microscope mount used with the hand-held OCT system.

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Case-control retrospective, comparative assessment.
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Visual acuity and OCT assessment before ERM surgery and at 1-, 3-, 6-, and 12-month follow-up after standard small-gauge PPV with iOCT feedback (iOCT DISCOVER group) or PPV with compulsory internal limiting membrane (ILM) peeling (conventional group). Visual acuity, central subfield thickness (CST), reoperation rate, and ERM recurrence were determined by record review and post hoc assessment of clinical OCTs after ERM peel.
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: Manuscript no. 2010-1291.

: Financial Disclosures: Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York. The funding organization had no role in the design or conduct of this research.

: The authors have made the following disclosures:

: Baker Hubbard, III – Peregrine Surgical, Ltd.

: Sunil Srivastava – Consultant – Bausch and Lomb; Consultant – Allergan; Consultant – Novartis; Advisory Board Member – Bausch & Lomb.

: The authors have no financial or proprietary interest with any of the content in this manuscript.

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Original articleIntraoperative Microscope-Mounted Spectral Domain Optical Coherence Tomography for Evaluation of Retinal Anatomy during Macular Surgery

Objective

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Methods

Macular Hole Imaging

Discussion

Acknowledgment

Am J Ophthalmol

Ophthalmology

High-definition and 3-dimensional imaging of macular pathologies with high-speed ultrahigh-resolution optical coherence tomography

Ophthalmology

Restored photoreceptor outer segment and visual recovery after macular hole closure

Am J Ophthalmol

Photoreceptor inner/outer segment defect imaging by spectral domain OCT and visual prognosis after macular hole surgery

Invest Ophthalmol Vis Sci

Foveal structure defined by spectral domain optical coherence tomography correlates with visual function after macular hole surgery

Eur J Ophthalmol

Spectral-domain optical coherence tomography images of inner/outer segment junctions and macular hole surgery outcomes

Graefes Arch Clin Exp Ophthalmol

Disruption of the photoreceptor inner segment-outer segment junction in eyes with macular holes

Retina

Correlation of visual recovery and presence of photoreceptor inner/outer segment junction in optical coherence images after successful macular hole repair

Retina

Original article
Intraoperative Microscope-Mounted Spectral Domain Optical Coherence Tomography for Evaluation of Retinal Anatomy during Macular Surgery