title: INTRAOPERATIVE SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING AFTER INTERNAL LIMITING MEMBRANE PEELING IN IDIOPATHIC EPIRETINAL MEMBRANE WITH CONNECTING STRANDS.
abstract: OBJECTIVE
  To report the intraoperative optical coherence tomography findings in idiopathic epiretinal membrane (ERM) with connecting strands and to describe the postoperative outcomes.
  
  
  METHODS
  A retrospective, case series study within a prospective observational intraoperative optical coherence tomography imaging study was performed. Epiretinal membranes with connecting strands were characterized on preoperative spectral domain optical coherence tomography images and assessed against corresponding intraoperative (after internal limiting membrane [ILM] peeling) and postoperative spectral domain optical coherence tomography images.
  
  
  RESULTS
  Eleven locations of the connecting strands in 7 eyes were studied. The connecting strands had visible connections from the inner retinal surface to the ERM in all locations, and the reflectivity was moderate in 8 locations and high in 3 locations. After ERM and ILM peeling, disconnected strands were identified in all of the intraoperative optical coherence tomography images. The reflectivity of the remaining intraoperative strands was higher than that of the preoperative lesions and appeared as "finger-like" and branching projections. The remaining disconnected lesions were contiguous with the inner retinal layers. Postoperatively, the intraoperative lesions disappeared completely in all locations, and recurrent formation of ERM was not identified in any eyes.
  
  
  CONCLUSIONS
  In ERM eyes with connecting strands, intraoperative spectral domain optical coherence tomography imaging showed moderately to highly reflective sub-ILM finger-like lesions that persist immediately after membrane and ILM peeling. Postoperatively, the hyperreflective lesions disappeared spontaneously without localized nerve fiber layer loss. The sub-ILM connecting strands may represent glial retinal attachments.
authors.affiliation: *Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina; †Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea; ‡Duke University School of Medicine, Durham, North Carolina; and §Department of Biomedical Engineering, Pratt School of Engineering, Durham, North Carolina.
authors.forename: Dong Heun
authors.initials: DH
authors.lastname: Nam
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Desouza
authors.forename: Paul
authors.initials: P
authors.lastname: Hahn
authors.forename: Vincent
authors.initials: V
authors.lastname: Tai
authors.forename: Monica B
authors.initials: MB
authors.lastname: Sevilla
authors.forename: Du
authors.initials: D
authors.lastname: Tran-Viet
authors.forename: David
authors.initials: D
authors.lastname: Cunefare
authors.forename: Sina
authors.initials: S
authors.lastname: Farsiu
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Izatt
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Toth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000473:pathology / Q000601:surgery; D019773:Epiretinal Membrane / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D011184:Postoperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
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