Intraoperative Spectral Domain Optical Coherence Tomography Characterization of Inner Retinal Abnormalities during Macular Surgery and the Relationship to Preoperative and Postoperative Morphology

Abstract

 

Purpose

 

To identify acute inner retinal abnormalities after inner limiting membrane (ILM) peeling for macular hole (MH) or epiretinal membrane (ERM) repair using intraoperative spectral-domain optical coherence tomography (SDOCT) and to correlate these abnormalities with preoperative and postoperative SDOCT retinal morphology.

 

Methods

 

We investigated preoperative (preop), intraoperative (intraop, after completion of ILM peeling), and postoperative (postop, mean 98 days (range 32-140)) SDOCT images obtained for the surgical eye of 11 patients from an IRB-approved study who had vitrectomy with ILM peel for idiopathic ERM (n=9) or idiopathic MH (n=1) and vitrectomy without ILM peel for idiopathic MH (n=1, control). No eye had a previous history of other retinal pathology, diabetes, or vitreoretinal surgery. The extent and location of abnormalities were correlated with the corresponding SDOCT images at different time points.

 

Results

 

Table 1 shows the patterns of observed inner retinal findings in corresponding intraop, preop and postop scans. Among the observed abnormalities were defects typical of those reported in dissociated optic nerve fiber layer (DONFL)¹. The control eye without an ILM peel demonstrated no intraop defects aside from a FTMH. ¹Nukada, et. al, IOVS (2013;54:2417-2428). Figure 2.

 

Conclusions

 

Intraop SDOCT allowed for characterization of transient and persistent inner retinal changes following macular surgery. Acute inner retinal abnormalities seen only intraop corresponded to a transient change after surgical manipulation. Preop and intraop findings not seen postop indicate a gradual resolution as a result of surgical intervention. Further studies will explore the relationship of intraop retinal defects to the development of postop morphologic changes such as DONFL.

 

 

Table 1.

 

* ERM with thickened retina or retinal striae in this location in few eyes made assessment difficult

 

**Although DONFL was not visible intraop, hyperreflective material with shadowing was present at the precise site on cross-sectional SDOCT B-scan.

 

Keywords: 762 vitreoretinal surgery • 550 imaging/image analysis: clinical