title: Membrane Peeling-Induced Retinal Alterations on Intraoperative OCT in Vitreomacular Interface Disorders From the PIONEER Study.
abstract: OBJECTIVE
  To assess retinal architectural alterations that occur following membrane peeling procedures and the impact of peel technique on these alterations utilizing intraoperative optical coherence tomography (iOCT).
  
  
  METHODS
  This is a subanalysis of the prospective PIONEER iOCT study of eyes undergoing a membrane peeling for a vitreomacular interface (VMI) disorder. Intraoperative scanning was performed with a microscope-mounted OCT system. Macroarchitectural alterations (e.g., full-thickness retinal elevations) and microarchitectural alterations (e.g., relative layer thickness alterations) were analyzed. Video/iOCT correlation was performed to identify instrument-tissue manipulations resulting in macroarchitectural alterations.
  
  
  RESULTS
  One hundred sixty-three eyes were included in the macroarchitectural analysis. Instrumentation utilized for membrane peeling included forceps alone for 73 eyes (45%), combined diamond-dusted membrane scraper (DDMS) and forceps for 87 eyes (53%), and other techniques in three eyes (2%). Focal retinal elevations were identified in 45 of 163 eyes (28%). Video/iOCT correlation identified 69% of alterations involved forceps compared to 26% due to DDMS. Sixteen percent of retinal alterations persisted 1 month following surgery. The microarchitectural analysis included 134 eyes. Immediately following membrane peeling, there was a significant increase in the ellipsoid zone to retinal pigment epithelium height (+20%, P < 0.00001) and the cone outer segment tips to retinal pigment epithelium height (+18%, P < 0.00001).
  
  
  CONCLUSIONS
  Significant subclinical retinal architectural changes occur during membrane peeling for VMI conditions. Differences in surgical instruments may impact these architectural alterations.
authors.affiliation: Ophthalmic Imaging Center Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Justis P
authors.initials: JP
authors.lastname: Ehlers
authors.affiliation: Ophthalmic Imaging Center Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States 2School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States.
authors.forename: Jaehong
authors.initials: J
authors.lastname: Han
authors.affiliation: Ophthalmic Imaging Center Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States 2School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Petkovsek
authors.affiliation: Ophthalmic Imaging Center Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Kaiser
authors.affiliation: Ophthalmic Imaging Center Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Rishi P
authors.initials: RP
authors.lastname: Singh
authors.affiliation: Ophthalmic Imaging Center Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Srivastava
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies; D012167:Retinal Perforations / Q000175:diagnosis / Q000601:surgery*; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D041623:Tomography, Optical Coherence / Q000379:methods*; D014741:Video Recording; D014821:Vitrectomy