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Steven John Ryder, Justin Townsend; Multimodal imaging including intraoperative optical coherence tomography (OCT) and en face OCT to visualize immediate effect and extent of internal limiting membrane (ILM) peeling in macular hole surgery.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):468.
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© ARVO (1962-2015); The Authors (2016-present)
Internal limiting membrane (ILM) peeling has been shown to improve the anatomical and visual outcomes in macular hole repair. The purpose of this report is to illustrate the benefit of intraoperative OCT and en face OCT an eye undergoing pars plana vitrectomy with ILM peeling. Intraoperative OCT can demonstrate immediate improvement in foveal contour while en face OCT is a novel modality to assess extent of ILM peeling following macular hole surgery.
A fifty-four year old Caucasian female with a full-thickness macular hole in her right eye underwent pars plana vitrectomy, ILM peeling, fluid-air exchange and 25% SF6 gas injection in her right eye. Intraoperative OCT images were recorded with the ZEISS OPMI LUMERA 700 and RESCAN 700. Postoperative en face OCT images were recorded with the Cirrus HD-OCT 5000.
Preoperative visual acuity was 20/200 in the right eye with a full-thickness macular hole. Following complete vitrectomy and staining of the ILM with indocyanine green, the ILM was peeled to a radius of at least two disc diameters and out to the vascular arcades. Intraoperative OCT immediately following ILM peel demonstrates marked improvement in the macular hole contour due to release of tractional forces. With the hole completely closed at postoperative day eight, the area of peeled ILM is highligted well by en face OCT. The hole closed entired Visual acuity improved to 20/50 at one month following surgery.
Intraoperative OCT and postoperative en face OCT are uniquely equipped to visualize the immediate effect of ILM peeling and confirm adequate removal, respectively.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Image 1. Intraoperative OCT before and immediately following ILM peeling. There is marked improvement in foveal contour and scattered small superficial flame hemorrhages above the retinal nerve fiber layer (orange arrows).
Image 2. A distinctly different shade of gray highlights the extent of the ILM peeling in this postoperative day 8 en face OCT (right) and correlates well with an intraoperative photograph immediately following peel (left).
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