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R. Ray, J. A. Fortun, D. E. Baranano, B. J. Schwent, B. E. Cribbs, G. B. Hubbard, III, S. K. Srivastava; Intraoperative Evaluation of Retinal Anatomy by Spectral-Domain Optical Coherence Tomography During Macular Hole Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2962.
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Optical coherence tomography has become an invaluable tool for diagnosis and management of retinal disease. Spectral-domain optical coherence tomography (SDOCT) provides high-resolution images and may detect abnormalities not found using the commonly employed time-domain OCT. We aimed to provide information to aid in macular surgery by evaluating and characterizing the changes of retinal anatomy during surgery for macular hole using a microscope-mounted SDOCT (Bioptigen, Inc; InVivoVue Clinic v1.2; Durham, NC).
Nine eyes of nine patients undergoing surgery for macular hole were evaluated using the microscope-mounted SDOCT during the procedure. Vertical and horizontal cuts through each macular hole was performed prior to induction of posterior hyaloid separation (if necessary), prior to internal limiting membrane (ILM) peeling, and post-ILM peel. Changes in retinal anatomy and macular hole size and structure were documented for each eye.
Five of the nine eyes required mechanical separation of the posterior hyaloid from the retina and nerve. Images before and after this step confirmed removal of the entire posterior hyaloid from the macula retina in 2 of 5 eyes. The other three eyes had residual posterior cortical vitreous/epiretinal membrane complex remaining. Removal of the ILM as judged by the operating surgeon was confirmed by SDOCT images taken after that step in eight of nine eyes (no confirmation OCT in one case). Size of the hole remained constant in 8 of 9 eyes and was slightly larger in one. Small scrolls of ILM were evident at the edge of the macular hole in all cases. Five cases had peeled membrane submitted for electron microscopy. Two were not identifiable and three were proven to be ILM.
Intraoperative SDOCT is a useful tool for confirmation of complete posterior hyaloid separation and ILM peel during macular hole surgery. In our small series it was safe and relatively efficient. Routine use of this technology in the operating room may have a role in macular surgery.
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