Application value assessment of intraoperative optical coherence tomography in vitreoretinal surgery

Authors: Tao Jiwei,  Chen Huan,  Shen Lijun,  Lin Jingjing,  Chen Yiqi,  Mao Jianbo,  Fang Jia
DOI: 10.3760/cma.j.cn115989-20190715-00309
Published 2022-01-10
Cite asChin J Exp Ophthalmol, 2022, 40(1): 35-40.

Abstract

Objective

To evaluate the application of intraoperative optical coherence tomography (iOCT) in vitreoretinal surgery.

Methods

An observational case series study was conducted.A total of 316 patients (316 eyes) who received vitreoretinal surgery and iOCT from January 2015 to December 2017 in Hangzhou Branch of Eye Hospital, Wenzhou Medical University were enrolled. The iOCT scanning time and result, the consistency between iOCT result and observation under the operating microscope as well as the influence of iOCT on surgical strategy were recorded.The postoperative adverse reactions and complications were observed.The study protocol was approved by an Ethics Committee of Eye Hospital, Wenzhou Medical University(No.2019-168-K-160). Written informed consent was obtained from all patients prior to any medical examination.

Results

There were 85.8% (271/316) of patients who successfully completed iOCT scanning, with an average scanning time of (3.54±2.30)minutes.Among the 271 successful eyes, there were 51 with idiopathic macular hole (IMH), 95 with epiretinal membrane, 50 with dense vitreous hemorrhage (VH), 30 with macular lamellar hole, 12 with vitreous macular traction syndrome, 33 with myopic maculopathy.There were 45 eyes, accounting for 16.6%, the iOCT results of which were inconsistent with the observation of operator under the operating microscope.There were 27 eyes, accounting for 10.0%, the surgical strategy of which was changed.The iOCT results of IMH showed that intra-retinal bridge connection appeared in 2 eyes after ILM peeling, then air tamponade was used.High-reflection strips on the edge of the MH after ILM peeling, called the Hole-door phenomenon, were found in 15 eyes, accounting for 32.6%.In MH with a diameter >400 μm, the postoperative best corrected visual acuity and continuity of outer limiting membrane were better in eyes with Hole-door phenomenon than eyes without Hole-door phenomenon.There were 8 eyes, accounting for 8.4%, showing residual membrane, 3 eyes of which received extra ERM peeling.There were 56 eyes, accounting for 58.9%, showing the secondary changes after membrane peeling.For 50 eyes with dense VH, there were 17 eyes showing the normal macular structure, accounting for 34%, and 33 eyes showing the abnormal macular structure, accounting for 66.0%.In addition, the macular structures of 14 eyes, accounting for 28.0%, observed in iOCT image were inconsistent with the intraocular microscope finding, and 11 of them received extra ERM peeling.

Conclusions

The application of iOCT in vitreoretinal surgery can guide the selection of reasonable surgical methods during operation, predict postoperative recovery as well as improve postoperative outcomes.

Key words:

Vitreoretinal surgery; Tomography, optical coherence, intraoperative; Retinal diseases; Macular lutea; Operation guide

Contributor Information

Tao Jiwei

Department of Ophthalmology, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China

Chen Huan

Department of Ophthalmology, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China

Shen Lijun

Department of Ophthalmology, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China

Lin Jingjing

Department of Ophthalmology, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China

Chen Yiqi

Department of Ophthalmology, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China

Mao Jianbo

Department of Ophthalmology, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China

Fang Jia

Department of Ophthalmology, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China

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