Intraoperative SD-OCT in macular surgery.
OBJECTIVE
Intraoperative use of spectral-domain optical coherence tomography (SD-OCT) using an OCT-mounted surgical microscope could provide additional information to predict visual outcomes of macular surgery and identify intraoperative changes in the macular anatomy that affect visual recovery.


METHODS
This interventional retrospective case study included 5 eyes of 5 consecutive patients with various macular pathologies. All patients underwent the standard surgery for idiopathic macular holes and epiretinal membranes (ERMs) using the same 25-gauge three-port pars plana technique. If present, the ERM was removed. The dye procedure was then repeated to stain and remove the internal limiting membrane (ILM). OCT images were obtained with the retinal map or cross-section program preincision, post-hyaloid elevation (if applicable), post-residual ERM peel (if applicable), and post-ILM peel.


RESULTS
In 3 of 5 patients, the intraoperative scan revealed an increased area of subretinal hyporeflectivity corresponding with a clinically visible "cuff" of retinal detachment. In 2 patients, the SD-OCT scan taken immediately after ERM removal helped find a cleavage plane for the subsequent ILM peeling, which could be further confirmed by a scan taken immediately after it. In 2 cases, the scans identified intraoperative complications that otherwise would not have been noted and allowed the surgeon to modify the next procedures during surgery.


CONCLUSIONS
Use of this technology in an operative setting can provide greater insight into the changes in retinal anatomy created during macular surgery.
San Giuseppe Hospital, University Eye Clinic, Milan, Italy. ilmiticopicchio@ gmail.com
Francesco
F
Pichi
Micol
M
Alkabes
Paolo
P
Nucci
Antonio P
AP
Ciardella
D000368:Aged; D000369:Aged, 80 and over; D019773:Epiretinal Membrane / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008266:Macula Lutea / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012167:Retinal Perforations / Q000175:diagnosis* / Q000601:surgery; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000295:instrumentation / Q000379:methods*; D014821:Vitrectomy / Q000379:methods*