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Alison Rogozinski, Tisileli Tuifua, Sunil K Srivastava, Peter K Kaiser, Ming Hu, Aleksandra Rachitskaya, Sumit Sharma, Rishi P Singh, Thuy K. Le, Leina Moani Lehua Lunasco, Francesca Fabe, Carmen Calabrise, Sarah Biehl, Sruthi Srinivasan, Jamie L. Reese, Justis P Ehlers; Comparative Evaluation of Surgical Outcomes of Intraoperative OCT-guided and Conventional Surgery for Epiretinal Membrane Peeling from the DISCOVER Study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1872. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
There is limited data regarding the comparative efficacy of intraoperative OCT (iOCT)-guided membrane peeling to conventional surgery for the removal of epiretinal membrane (ERM). Combined internal limiting membrane (ILM) and ERM peeling has demonstrated good success with low reoperation rates. The purpose of this study was to compare outcomes for ERM surgery between conventional ILM/ELM peeling to iOCT-guided ERM removal.
The DISCOVER study is an IRB-approved prospective consecutive case series evaluating the impact of iOCT on ophthalmic surgery. For this analysis, a case-control retrospective comparative assessment was performed between eyes in the DISCOVER study undergoing surgery for ERM and a cohort of eyes with ERM that underwent conventional surgery with mandated ILM removal. In the iOCT cohort, initial staining with indocyanine green (ICG) was performed with removal of ERM +/- ILM. After the initial peel, iOCT was performed and if complete ERM removal was confirmed, no additional peeling/staining was performed. In the ILM/ERM cohort, initial staining was performed. Following initial peel, additional ICG staining was performed after ERM removal and any residual ILM was removed at that time. Visual acuity, central subfield thickness (CST), and reoperation rates were evaluated up to 6 months following surgery.
The iOCT group included 167 eyes and the ILM/ERM group included 115 eyes. The mean baseline CST was 468.9 microns in the iOCT group and was 460.2 microns in the ILM/ERM group (p = 0.510). Baseline mean VA was 20/60 in the iOCT group and 20/51 in the ILM/ERM group (p=0.24). Postoperatively, CST demonstrated significant improvement with a mean CST of 370.9 (-20.9%) in the iOCT group and a mean CST of 362.7 (-21.1%) in the ILM/ERM group. At 6 month follow-up, the mean visual acuity for the iOCT group was 20/33 and for the ILM/ERM group was 20/31 (p=0.34). No patients required reoperation for recurrent ERM (0%).
This analysis suggests that iOCT-guided ERM peeling demonstrates similar visual acuity and anatomic improvements without requiring sequential ILM peeling. Additionally, the reoperation rate was quite low in both groups. A future randomized comparative trial is being planned to further explore the differences of these techniques.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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