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V. B. Mahajan, J. C. Folk, S. R. Russell, H. C. Boldt, E. M. Stone, K. Lee, M. D. Abràmoff; Iowa Membrane Maps: SD OCT Guided Therapy for Epiretinal Membrane. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3604.
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The surgical anatomy of macular epiretinal membranes (ERMs) is variable and difficult to visualize. Therefore it can be challenging to create a surgical plane that removes the membrane without damaging the underlying retina. We tested an automated method to identify the optimal surgical plane using Spectral Domain (SD) OCT.
15 eyes with ERMs (9 idiopathic, 6 secondary to retinal detachment, uveitis, or diabetes) underwent automated analysis using our algorithm to segment Sub-ERM spaces. ERM images were registered to the fundus image, and sub-ERM volumes were displayed on a 3D Membrane Map using false color to project the depth of space. During vitrectomy, forceps were used to grasp the membrane over the predicted largest sub-ERM volumes and initiate the peel.
Membrane Maps correctly predicted a sub-ERM space and surgical plane in all cases. In 13 eyes, the first grasp succeeded in peeling the entire ERM in a single sheet. In 2 eyes with ERM-retina adhesions, a second grasp was required. Areas without sub-ERM spaces were predictive of greater ERM-retina adhesion. OCT confirmed complete ERM removal in all cases scanned, and visual outcomes were similar to previous reports. There were no intraoperative or other complications during the 3-months follow up. Figure 1. Automated Sub-ERM space segmentation and 3-dimensional Iowa Membrane Map showing largest sub-ERM volume.
Iowa Membrane Maps allow objective surgical planning for ERM removal. This technique has the potential for greater safety and surgical predictability.
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