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D. Heinrich, Sabrina Bohnacker, M. Ali Nasseri, Nikolaus Feucht, C.P. Lohmann, Mathias M Maier; Use of intraoperative Optical Coherence Tomography (i-OCT) in vitreous haemorrhage. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4487.
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© ARVO (1962-2015); The Authors (2016-present)
High resolution spectral domain OCT (SD-OCT) is a gold standard technique in diagnosis, management and monitoring of patients with vitreoretinal diseases. Preoperative diagnostics for evaluation of intraocular and retinal status in patients with vitreous haemorrhage or hazy vitreous are limited, thus final therapeutic decisions can only be made during explorative vitrectomy. We evaluated the use of i-OCT as a real-time additional diagnostic tool during surgery.
We examined ten patients with vitreous haemorrhage and hazy vitreous. Due to the limited view of the posterior segment prior to surgery, ultrasound was performed. During vitrectomy, intraoperative real-time OCT was applied as an additional diagnostic tool.Exemplarily, we present the case of a 51 y/o male with Terson syndrome on both eyes. Visual acuity was "light perception" on the right and "hand motion" on the left eye. Preoperative funduscopy was not possible due to very dense haemorrhages. Sonographically, a hyperreflective, preretinal membrane with insertion at the papilla and signs of retinal detachment was identified on both eyes. Therefore, the tentative diagnosis of retinal detachment was made and a vitrectomy was performed. I-OCT was applied to determine the macula and the retina.
In all patients, i-OCT allowed real-time evaluation of the retinal status. Further surgical strategy (i.e. necessity for ERM or ILM peeling) was based on the i-OCT. The decision for the postoperative tamponade was facilitated.In the patient with Terson syndrome, the tentative diagnosis of retinal detachment was declined upon inspection during vitrectomy of the right eye. However, clinically there appeared to be a macular hole. I-OCT showed a regular scan of the macula with accumulated blood on the fovea. Therefore, ILM peeling was not necessary. On the left eye, the tentative diagnosis of complete retinal detachment was confirmed upon vitrectomy. I-OCT showed an older retinal detachment with retinal wrinkling.
I-OCT is highly useful as additional intraoperative diagnostic tool in patients with vitreous haemorrhage and hazy vitreous. It facilitates real-time diagnosis and promotes therapy decisions during surgery.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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