Premium
The use of intraoperative spectral domain optic coherence tomography in vitreoretinal surgery: The evaluation of efficacy
Author(s) -
Lytvynchuk L.,
Glittenberg C.,
Binder S.
Publication year - 2015
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2015.0667
Subject(s) - pars plana , medicine , vitrectomy , macular hole , optical coherence tomography , ophthalmology , retinal pigment epithelium , epiretinal membrane , retinal detachment , retinal , cataract surgery , surgery , visual acuity
Purpose To evaluate the feasibility of intraoperative spectral domain optic coherence tomography ( iSD ‐ OCT ) in challenging cases during pars plana vitrectomy ( PPV ). Methods Intraoperative imaging was performed using the first commercially available iSD ‐ OCT system Rescan 700, fully integrated into the surgical microscope OPMI Lumera 700 (Zeiss, Oberkochen, Germany). The feasibility of iSD ‐ OCT was assessed during three 23‐gauge PPV cases: large macular hole ( MH ) with inverted internal limiting membrane ( ILM ) flap technique (Case #1), vitrectomy for asteroid hyalosis with age‐related macular degeneration (Case #2), vitrectomy for morning glory syndrome with retinoschisis and exudative retinal detachment (Case #3). Results Case #1. The use of iSD ‐ OCT facilitated to safely initiate ILM flap, to form inverted flap, to invert the flap into the MH , to control position of the forceps concerning retinal layers, and to confirm the MH covering with the ILM remnants at the end of the surgery. Case #2. Standard OCT was not available before the surgery due to opaque vitreous. Intraoperative SD ‐ OCT imaging assisted to reveal epiretinal membrane ( ERM ), retinal pigment epithelium detachment, intraretinal fluid and drusen. These findings required additional surgical steps: ERM removal and injection of anti‐ VEGF at the end of the surgery. Case #3. In the case of morning glory syndrome iSD ‐ OCT facilitated to remove the strongly adherent posterior hyaloid, to control ILM flap initiation, to perform the peeling over the detached retina, to aspirate residual fluid after fluid/air exchange. Conclusions The use of iSD ‐ OCT facilitates real‐time simultaneous to surgical workflow visualisation of tissue behaviour and surgical manoeuvres during pars plans vitrectomy. The obtained information can improve surgical technique and influence the decision making in difficult cases.