Macroarchitectural Intraoperative Retinal Alterations Following Membrane Peeling Visualized with Intraoperative OCT in the PIONEER Study

Abstract

 

Purpose

 

To assess the retinal macroarchitectural alterations that occur during membrane peeling for vitreomacular interface (VMI) disorders utilizing intraoperative OCT (iOCT)

 

Methods

 

The PIONEER study is a prospective study examining iOCT in ophthalmic surgery. Eyes undergoing membrane peeling were evaluated with video/iOCT correlation. Clinical variables assessed included membrane peeling technique (e.g., diamond-dusted membrane scraper [DDMS], forceps). iOCT images were reviewed for macroarchitectural changes (e.g., inner and full-thickness retinal changes). A microscope mounted portable SD-OCT probe (Bioptigen, Research Triangle Park, NC) was used to obtain preincision and post-peel iOCT images. Postoperative OCT images were analyzed at 1 week and 1 month.

 

Results

 

Of the total 163 eyes, post-peel retinal changes were noted by iOCT in 45 eyes (28%). Inner retinal elevations were noted in 38 eyes (23%), and 8 eyes (5%) had full-thickness retinal elevations. Based on video/iOCT correlation, 95% of the retinal changes correlated with instrument utilization. Direct peel initiation resulted in 47% of the changes and indirect pulling during completion of peel resulted in 48% of the changes. The retinal elevations occurred in 33% of the eyes when using forceps-only and in 23% of the eyes when using both forceps and a DDMS (p= 0.16, chi square). At 1-week post-op, 19% of the retinal changes persisted as focal inner retinal thickening or thinning. No full-thickness retinal changes persisted. At 1-month post-op, 60% of inner retinal thickening had resolved, while all focal retinal thinning persisted.

 

Conclusions

 

Significant subclinical macroarchitectural changes occur during membrane peeling for VMI conditions that are directly related to instrument manipulations. iOCT technology is able to identify these changes. There was a trend towards increased alterations with forceps-only technique compared to using a DDMS for peel initiation. Inner retinal changes persisted in many eyes at 1 month postoperatively. Further research is needed on the visual effects of these changes and how to minimize these changes during surgery.  

 

A: preincision iOCT image; B: post-peel iOCT image; C: iOCT-generated fundus map; D: correlated surgery video

 

 

A, B: preoperative OCT-generated fundus map and OCT image; C, D: postoperative OCT-generated fundus map and OCT image