Purchase this article with an account.
D. E. Baranano, J. A. Fortun, R. Ray, L. Charkoudian, C. Bergstrom, B. Cribbs, B. Schwent, G. Hubbard, III, S. Srivastava; Intraoperative Spectral-Domain Optical Coherence Tomography for Macular Pucker Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):269.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Optical coherence tomography has become an integrated part of retinal care in the clinic, elucidating the anatomy of the vitreo-retinal interface and quantifying pathologic changes such as cystoid macular edema and subretinal fluid. Spectral-domain optical coherence tomography (SDOCT) allows more rapid image acquisition, providing higher-resolution images and more complete mapping. We have adapted SDOCT for the peri-operative setting to better understand how our surgical interventions affect macular anatomy and to guide our surgical decisions. We provide information to aid in macular surgery by evaluating and characterizing the changes of retinal anatomy during surgery for macular pucker using a microscope-mounted SDOCT (Bioptigen, Inc; InVivoVue Clinic v1.2; Durham, NC).
Seventeen eyes of 17 patients undergoing surgery for macular pucker were evaluated using the microscope-mounted SDOCT during the procedure. Vertical and horizontal images through each macular pucker were obtained before and after removal of the epiretinal membrane. Additional imaging was performed after removal of the internal limiting membrane (ILM) for cases in which the ILM was removed as a separate step.
High quality images of the macula were obtained before and after membrane peel in each case. Securing the camera to the microscope allowed quicker and better imaging than was possible with a handheld technique. Overall surgical time was not significantly different from cases that were not imaged. No complications occurred. Structural improvement was seen in a majority of cases within five minutes of the epiretinal membrane being removed. In two cases, small localized neurosensory retinal detachments developed after membrane removal, clearly demonstrated on SDOCT imaging, but not appreciated under the operative microscope. SDOCT imaging after initial membrane peel often revealed residual membrane that was not appreciated clinically. After then peeling the ILM, SDOCT imaging demonstrated complete removal of residual membrane.
Microscope-mounted intraoperative SDOCT imaging reveals changes in macular anatomy safely, rapidly and efficiently, providing additional information to the surgeon that may guide perioperative decision-making.
This PDF is available to Subscribers Only