July 2020
Volume 61, Issue 9
Free
ARVO Imaging in the Eye Conference Abstract  |   July 2020
Strong adhesion of RPE to photoreceptors explains in part the failure of macular detachment technique for large macular hole closure: iOCT findings
Author Affiliations & Notes
  • Lyubomyr M. Lytvynchuk
    Department of Ophthalmology, Justus Liebig University, Giessen, Hessen, Germany
    Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria
  • Andrii Ruban
    Ophthalmology, Clinic "Ocular", Kyiv, Ukraine
  • Knut Stieger
    Department of Ophthalmology, Justus Liebig University, Giessen, Hessen, Germany
  • Footnotes
    Commercial Relationships   Lyubomyr Lytvynchuk, None; Andrii Ruban, None; Knut Stieger, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2020, Vol.61, PB0034. doi:
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      Lyubomyr M. Lytvynchuk, Andrii Ruban, Knut Stieger; Strong adhesion of RPE to photoreceptors explains in part the failure of macular detachment technique for large macular hole closure: iOCT findings. Invest. Ophthalmol. Vis. Sci. 2020;61(9):PB0034.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Macular detachment (MD) with subretinal injection of balance salt solution (BSS) belongs to the newest techniques to treat large chronique macular holes (MH). Subretinal injection of BSS is meant to detach MH edges and to reduce the tension/stiffness of the retina, which shall support the re-approximation of MH edges and closure of MH. However, the failures of MH closure still exist. We report the results of a prospective, non-randomized, observational clinical study to reveal new information about surgical flow of MD technique on eyes with large MH, which could influence the closure rate using intraoperative optical coherence tomography (iOCT).

Methods : Seven patients (mean age 64.3 years, females, 7 eyes) with large MH (>700 μm) underwent 3-port pars plana vitrectomy (PPV) with MD technique. Subretinal BSS injection was performed in 4 quadrants (4 blebs) about 1 mm from MH edges. For iOCT imaging, a microscope integrated system Rescan™700 (Carl Zeiss Meditech, Oberkochen, Germany) was used during all surgical steps. The iOCT data were post-processed after the surgery using graphic software (ImageJ 1.48V, NIH, USA) and analyzed for morphological alterations at the retinal pigment epithelium (RPE) and photoreceptor outer segment (POS) interface. All patients underwent standard pre- andpostoperative examination and signed a consent.

Results : In all cases after subretinal BSS injection, iOCT revealed a strong adhesion between RPE and POS at the edges of MH base. In spite of visually percepted MD, iOCT data showed that only about 5% to 20% of MH edge circumference (360 degrees) were detached (mostly temporally). The subretinal blebs merged with each other outside the MH area. The height or size of the bleb did not correlate with the size of the detachment at MH edges. Stronger RPE to OPS adhesion seemed to be present in the nasal quadrants. During postoperative period, in 3 cases (43%) MH remained open, which necessitated reoperation.

Conclusions : The intraoperative flow of MD technique appears to be incompletely understood. iOCT data revealed the strong adhesion between RPE and POS at MH edges, which can prevent re-approximation of MH edges. Visually observed detachment of MH seems to be an optical misperception. iOCT findings partially explain the rate of MH non-closure after MD technique.

This is a 2020 Imaging in the Eye Conference abstract.

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