Purpose:
Currently, there is no consensus regarding the necessity of internal limiting membrane (ILM) peeling during surgical epimacular membrane (EMM) removal. The current study examines the use of intraoperative, handheld spectral domain optical coherence tomography (HH-OCT) as an aid to surgical EMM removal combined with ILM peeling. We hypothesize that ILM peeling is necessary to restore normal retinal anatomy in EMM surgery.
Methods:
A single-center, retrospective chart review identified patients who underwent EMM removal with brilliant blue G assisted ILM peeling and concurrent intraop HH-OCT imaging from May 2011 through November 2011. Inclusion criteria were documented pre- and 1 week post-op best corrected visual acuity (BCVA), as well as intraop HH-OCT images taken at the start of surgery, after EMM removal, and following ILM peeling. All OCT scans were obtained using with a HH-OCT system mounted to a stand (iVue with iStand, OptovueTM). Outcome measures included change in retinal distortion on OCT imaging before and after ILM peel as determined by two independent examiners, comparison of pre-and post-op BCVA, and importance of OCT images to surgical decision making.
Results:
10 patients were identified who met inclusion criteria. OCT image analysis revealed a significant decrease in retinal distortion after ILM peeling in 6 (Group 1) patients and mild to moderate change in 4 (Group 2) patients. Mean logMAR pre-op BCVA was 0.67 and mean post-op logMAR BCVA was 0.31, with 7 out of 10 patients reporting subjective improvement in visual distortion. Scan results guided intraop decision making in 2 of 10 cases. No significant difference in final BCVA was found between groups.
Conclusions:
As demonstrated by intraoperative OCT images, study results support ILM peeling as an important step in restoring normal retinal appearance during surgical EMM removal. Future investigation is warranted to determine if anatomical changes resultant from ILM peeling are necessary for improved functional outcomes.
Keywords: retina • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • imaging/image analysis: clinical