Manipulation of preretinal proliferative membranes using intraoperative optical coherence tomography during vitrectomy for proliferative diabetic retinopathy

Abstract

Purpose : A safe and effective manipulation of the preretinal proliferative membranes is crucial for treating proliferative diabetic retinopathy (PDR). This study aimed to demonstrate the utility of intraoperative optical coherence tomography (iOCT) during vitrectomy for PDR.

Methods : In this retrospective study, we reviewed the surgical procedures adopted in 11 patients (13 eyes) who underwent vitrectomy for PDR with proliferative membranes at Yamagata University Hospital between January 2016 and May 2016. Patients were treated using 25-gauge pars plana vitrectomy. The proliferative membranes were removed using a vitreous cutter. Before and after these procedures during the surgery, the proliferative membranes were observed using iOCT RESCAN (Carl Zeiss Meditec, Germany). The iOCT cross-sectional images were used to evaluate the distance between the proliferative membranes and retinas and to observe the structures of the proliferative membranes.

Results : Correlations between the proliferative membranes and retinas in all patients were evaluated using the iOCT images by measuring the distance between them and evaluating the structures of the proliferative membranes. The segmentation of the proliferative membranes was possible using the vitreous cutter alone under the iOCT guidance as it allowed us to evaluate the distance between the proliferative membranes and retinas and avoid the damage to the retinas. The mean distance between the proliferative membranes and retinas was 789.7 ± 146.6 (SD) μm. Using iOCT, the proliferative membranes were observed to be formed as the continuous structures of the vitreous cortex. The images helped in understanding the pathogenesis of proliferative membrane formation in each PDR patient; vitreoschisis was also observed in all patients using iOCT. Cross-sectional images were used as a guide to remove the vitreous cortex and to avoid proliferative membrane relapse, which reformed on the residual cortex as the scaffolding. Intraoperative adverse events did not occur in any patient.

Conclusions : iOCT is a very useful technique to accurately identify the pathological structures of the proliferative membranes in PDR patients and to guide their safe and effective removal during surgery.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.