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Joshua Robinson, Robin Ray, G B. Hubbard, III, Chris Bergstrom, Hans E. Grossniklaus, Sunil Srivastava; Intraoperative Spectral Domain OCT Evaluation of Internal Limiting Membrane Stripping in Macular Hole and Macular Pucker Repair. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2203.
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To correlate pathologic findings of internal limiting membrane (ILM) resection with intraoperative spectral domain optical coherence tomography (SD-OCT) during pars plana vitrectomy.
A retrospective chart review was performed and identified 14 patients that underwent vitreoretinal surgery for macular pucker (MP, n=8) or full-thickness macular hole (FTMH, n=6). All surgeries were performed by experienced vitreoretinal surgeons (SS, GBH, CB) utilizing 20-guage, 23-guage, or 25-guage techniques with either Indocyanine Green or Triamcinolone Acetonide employed to stain the ILM, based on surgeon preference. All 6 FTMH cases and 2 of the MP cases involved peeling the ILM and associated epiretinal membrane (ERM) together, while the remainder of MP cases involved peeling the ILM and ERM separately. Intraoperative SD-OCT scans were obtained before and after each membrane peel. Tissue specimens from each membrane peel were submitted for light and electron microscopy.
Five of the 6 FTMH cases were associated with an identifiable ILM edge on intraoperative SD-OCT, with all but one case demonstrating ILM on light and electron microscopy of resected membranes. Of the 14 submitted MP tissue samples (2 membranes from 2 single peel cases, and 12 membranes from 6 separate peel cases), 11 were recovered and analyzed. For all 11 cases, light and electron microscopic findings were consistent with clinical impression, however, only 1 post ILM-peel SD-OCT scan demonstrated a definite ILM edge. All of the OCT scans without identifiable ILM edges demonstrated a highly corrugated post-peel retinal surface with identifiable epiretinal membrane edges, while those with a visible ILM edge had a much smoother post-peel retinal surface.
Identification of an ILM edge on intra-operative SD-OCT was a reliable indicator of ILM resection in FTMH repair associated with mild epiretinal membranes without underlying retinal distortion, but not in cases of macular pucker repair associated with dense epiretinal membranes and highly corrugated retinal surfaces.
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