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D.V. Do, M. Cho, Q.D. Nguyen, S.M. Shah, J.T. Handa, P.A. Campochiaro, I. Zimmer–Galler, J.U. Sung, J.A. Haller; Impact of Optical Coherence Tomography on Surgical Decision–Making in Epiretinal Membrane and Vitreo–Macular Traction . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3629.
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Purpose: To compare retinal surgeons’ management of epiretinal membranes (ERM) and vitreo–macular traction (VMT) based on standard clinical examination (using stereoscopic slit–lamp biomicroscopy) with management based on examination supplemented by optical coherence tomography (OCT). Methods: Prospective masked clinical case series analyzing the surgical recommendations made by retina specialists at the Wilmer Eye Institute to patients with macular disorders, with and without the assistance of OCT. Surgeons first assessed, based on the clinical exam only, whether ERM or VMT was present, questionably present, or not present, and made a provisional management recommendation. An experienced OCT technician, masked to the findings on the clinical exam, performed the OCT scanning. The treating retina specialist then reviewed the OCT images and indicated the presence or absence of ERM and VMT. Recommendations for surgical intervention based on clinical exam findings only compared with clinical exam plus OCT findings were evaluated. Results: Six retina specialists participated and examined a total of 84 eyes of 73 adult patients. ERM was identified in 66 (78.6%) of 84 eyes using clinical exam compared to 72 (85.7%) of 84 eyes using OCT. OCT detected ERM in 6 (37.5%) of 16 eyes in which ERM was not diagnosed with clinical exam (P<0.005). VMT was identified in 5 (6%) of 84 eyes using clinical exam compared to 18 (21.4%) of 84 eyes using OCT (P<0.005). OCT detected VMT in 9 (12.3%) of 73 eyes in which VMT was not diagnosed with clinical exam, and OCT detected VMT in 4 (66.7%) of 6 eyes in which VMT was questionably present (P<0.005). Surgical intervention was recommended in 33 cases: 19 (57.6%) based on clinical exam alone, and 14 (42.4%) based on the combination of clinical exam and OCT findings (P<0.005). Conclusions: OCT is more sensitive than clinical exam in detecting both ERM and VMT. OCT is especially useful in diagnosing VMT and identified it in 13 (72.2%) of 18 cases in which clinical exam did not. OCT also influenced the recommendation for surgical intervention in 42.4% of patients scheduled for surgery. In patients with ERM or suspected VMT, OCT is likely to provide useful information that may affect the clinician’s therapeutic recommendations.
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