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Justis Ehlers, Bryan Roth, Peter Kaiser, Rishi Singh, Sunil Srivastava; Impact of Surgical Peeling on Retinal Microarchitecture in Epiretinal Membrane Surgery Visualized with Intraoperative Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3308.
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To assess the retinal architecture changes that occur during epiretinal membrane (ERM) surgery utilizing intraoperative optical coherence tomography (iOCT).
Consecutive multi-surgeon case series of eyes undergoing ERM surgery with concurrent iOCT imaging. A microscope-mounted spectral domain OCT portable probe was utilized for iOCT imaging at various surgical milestones. Qualitative and quantitative image analysis was performed for architectural changes, including central foveal thickness, IS/OS to RPE thickness, and cone outer segment tips to RPE thickness, prior to and after membrane peeling.
Twenty-six eyes of 26 patients underwent ERM surgery with concurrent iOCT imaging. Instrumentation utilized for membrane peeling included the diamond dusted membrane scraper alone (2), forceps alone (13), and combined membrane scraper and forceps (11). Qualitative analysis of iOCT images revealed focal areas of retinal elevation in 31% of cases at the initiation site of membrane peeling. Increased subretinal hyporeflectivity was noted in areas where peeling had been performed.. Quantitative analysis revealed a trend towards reduced central foveal thickness following membrane peeling (435 microns vs 420 microns, p = 0.13) and a significant increase in the COST/RPE gap (26 microns vs 32 microns, p = 0.02). Imaging with iOCT provided the surgeon with new information in 15% of cases that resulted in additional membrane peeling.
Significant retinal architectural changes occur during surgical removal of ERM that are noted with iOCT. The functional significance of these changes is not known and further research is needed to better understand the visual significance of these alterations. Surgical feedback provided by iOCT appears to provide important information to the surgeon, which may impact the surgical approach to a procedure.
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