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Sabrina Bohnacker, M. Ali Nasseri, Nikolaus Feucht, Mathias M Maier, Chris Lohmann; Intraoperative Optical Coherence Tomography (iOCT) guided intra- and subretinal surgery – a new surgical technique. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5002.
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© ARVO (1962-2015); The Authors (2016-present)
High resolution iOCT enables the simultaneous visualization of the biomicroscopic image and the OCT-image of all retinal layers, which allows the surgeon a real-time evaluation of retinal morphology before, during and after surgical manipulation. We investigated the use of iOCT-guidance in intra- and subretinal surgeries.
Retrospective, interventional case series of 5 eyes of 5 patients, 2 patients with persisting cystoid macular edema (CME) resistant to standard treatment and 3 patients with neovascular age-related macular degeneration (AMD) complicated by submacular haemorrhage (SMH). In patients with persisting CME a cystoid puncture with a 40G subretinal injection needle has been performed under guidance of a microscope-integrated iOCT. The same iOCT has been used to guide the subretinal application of recombinant tissue plasminogen activator (rtPA) in patients with SMH.
In all cases iOCT gave the surgeon a visual feedback about instrument-tissue-interaction and the exact position of the needle-tip. A controlled puncture and well regulated aspiration of intraretinal fluid or injection of rtPA was possible. Compared to preoperative, visual acuity (VA) had improved in 3 eyes, remained stable in 1 eye and decreased in one eye.Exemplarily, we present two cases: 1) Case of a 69 y/o male with diabetic macular edema on the left eye, who received multiple intravitreal anti-VEGF and steroid injections as well as pars plana vitrectomy with membrane peeling. VA was 1,54 logMAR. OCT-morphologically a large central intraretinal serous space was identified. Due to unsufficient treatment success by then, an iOCT-guided puncture of the cystoid and intraretinal fluid aspiration has been performed. Intraoperatively the reduction of the cystoid size could be monitored via iOCT. After surgery VA improved to 0,8 logMAR and was stable for 20 weeks. 2) Case of a 77 y/o male with SMH due to AMD. VA was counting fingers. RtPA has been applicated into the subretinal space by iOCT guided positioning of a 40G subretinal injection needle at the margin of the SMH. 3 weeks after surgery VA was 0,52 logMAR.
Thanks to iOCT, microstructural intra- and subretinal anatomies are today visible intraoperatively. Due to this new dimension of visualization, iOCT-guidance faciliates new surgical strategies in terms of more precise and controlled intra- and subretinal procedures.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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