Abstract
AbstractPurpose: To analyse the clinical significance of signal shadowing during intraoperative optical coherence tomography (iOCT) assisted vitreoretinal surgery (PPV) caused by vitreoretinal instruments (VRI), dyes, and vitreous substitutes and to quantify its impact on iOCT imaging.Methods: In this retrospective observational study, imaging data from thirty‐five (35) patients undergoing an iOCT‐assisted PPV with Rescan® 700 (Zeiss, Oberkochen, Germany) were analysed. The iOCT image data were divided into three groups: VRI (17 cases), tissue dyes (8 cases), and vitreous substitutes (10 cases). The images were then post‐processed using a graphic software (histogram, grey level (GL)) and compared with paired image controls without clinically perceptive interference to measure the grade of picture quality distortion. Data were statistically analysed.Results: The intraocular portion of all VRI caused a high average GL interference compared to controls (26.9 ± 2.3 vs. 35.9 ± 0.83; p < 0.05), obscuring the area of interest. The instruments' tips produced a low‐grade shadowing, allowing the underlying tissue to be distinguished. The stains analysed demonstrated a wide interference range, indocyanine green (9.2 ± 1.4) and triamcinolon acetonide (13.9 ± 10.0) showed a high shadowing, while lutein‐based dye (38.4 ± 6.4) and Brilliant Blue (39.9 ± 3.3) exhibited no significant distortion. All vitreous substitutes analysed showed an insignificant shadowing effect on iOCT (Air 42.9 ± 5.1, PFCL 46.0 ± 5.1 vs. 44.5 ± 0.32; p < 0.05).Conclusions: All intraocular instruments showed a significant image interference during iOCT assisted surgery. All dyes except Brilliant Blue produced additional shadowing effect compared to controls. Implementation of new imaging techniques or/and materials with low‐grade interference for surgical instruments could overcome a clinically relevant shadow effect on iOCT and maximize the technology's visual accuracy.
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