Analysis of Architectural Retinal Changes Utilizing Intraoperative OCT Following Surgical Intervention with the Sharkskin Forceps

Abstract

Purpose : To assess for retinal alterations immediately following membrane peeling procedures with the Finesse Sharkskin ILM Forceps (Alcon, Ft Worth, TX) using intraoperative optical coherence tomography (iOCT).

Methods : A post-hoc analysis of the IRB-approved prospective DISCOVER iOCT study was performed to evaluate iOCT findings in eyes that underwent membrane peeling procedures with the Finesse Sharkskin Forceps, an FDA-cleared handheld membrane peeling device. The forceps were utilized as part of the standard-of-care surgical procedure. In the DISCOVER study, a standardized imaging iOCT protocol is utilized with imaging obtained at various pre-determined time points in the surgery. Pre-peel and post-peel iOCT video and images were evaluated for each eye to assess for post-peel anatomic alterations. Surgical video/iOCT correlation was conducted to evaluate the etiology of anatomic alterations, such as instrument-tissue interaction vs indirect peeling forces.

Results : Thirty-two eyes were included in the analysis with a primary diagnosis of either epiretinal membrane for 22 eyes (69%) and full thickness macular hole for 10 (31%). Ten eyes (31%) underwent complete membrane peeling with Sharkskin Forceps, and 22 eyes (69%) underwent combined peeling with membrane loop-induced edge initiation with peel completion performed with the Sharkskin Forceps. Three eyes (9%) had focal retinal alterations identified on iOCT following tissue-instrument interaction with Sharkskin Forceps demonstrating focal full thickness retinal elevations. Two eyes (6%) had focal inner retinal elevations and one eye (3%) had a full-thickness retinal elevation that were not related to direct tissue-instrument interaction but rather indirect peeling forces. All of these alterations were subclinical (i.e., not visible without iOCT). No intraoperative adverse events occurred.

Conclusions : iOCT-identified architectural alterations related to direct-tissue instrument interaction was relatively infrequent (<10%) with similar frequency to previously reported alterations with other surgical instruments. Further longitudinal comparative research is needed to better understand clinical impact of various peeling methods.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.