The use of intraoperative spectral domain optic coherence tomography in vitreoretinal surgery: The evaluation of efficacy

Abstract

PurposeTo evaluate the feasibility of intraoperative spectral domain optic coherence tomography (iSD‐OCT) in challenging cases during pars plana vitrectomy (PPV).MethodsIntraoperative imaging was performed using the first commercially available iSD‐OCT system Rescan 700, fully integrated into the surgical microscope OPMI Lumera 700 (Zeiss, Oberkochen, Germany). The feasibility of iSD‐OCT was assessed during three 23‐gauge PPV cases: large macular hole (MH) with inverted internal limiting membrane (ILM) flap technique (Case #1), vitrectomy for asteroid hyalosis with age‐related macular degeneration (Case #2), vitrectomy for morning glory syndrome with retinoschisis and exudative retinal detachment (Case #3).ResultsCase #1. The use of iSD‐OCT facilitated to safely initiate ILM flap, to form inverted flap, to invert the flap into the MH, to control position of the forceps concerning retinal layers, and to confirm the MH covering with the ILM remnants at the end of the surgery. Case #2. Standard OCT was not available before the surgery due to opaque vitreous. Intraoperative SD‐OCT imaging assisted to reveal epiretinal membrane (ERM), retinal pigment epithelium detachment, intraretinal fluid and drusen. These findings required additional surgical steps: ERM removal and injection of anti‐VEGF at the end of the surgery. Case #3. In the case of morning glory syndrome iSD‐OCT facilitated to remove the strongly adherent posterior hyaloid, to control ILM flap initiation, to perform the peeling over the detached retina, to aspirate residual fluid after fluid/air exchange.ConclusionsThe use of iSD‐OCT facilitates real‐time simultaneous to surgical workflow visualisation of tissue behaviour and surgical manoeuvres during pars plans vitrectomy. The obtained information can improve surgical technique and influence the decision making in difficult cases.