Intraoperative Optical Coherence Tomography Research Articles

Identification and Management of a Central Type 2 Big Bubble in Deep Anterior Lamellar Keratoplasty

Purpose: The purpose of this study was to document a case of central type 2 bubble formation during deep anterior lamellar keratoplasty and discuss its intraoperative management. Methods: A rare case of central type 2 bubble formation with no peripheral extension beyond the trephination mark was documented with operative video and concurrent intraoperative optical coherence tomography imaging. Results: The type 2 bubble was decompressed with a needle intraoperatively, and deep anterior lamellar keratoplasty was successfully performed without perforation of Descemet membrane. Conclusions: Identifying formation of a type 2 bubble during deep anterior lamellar keratoplasty is crucial in avoiding perforation of Descemet membrane. This case shows that the behavior of type 2 bubbles can be different than what has been widely reported. It is hoped that this will aid the surgeon in identifying a type 2 bubble and in properly managing it intraoperatively.

Comparison of three fundus inspection methods during phacoemulsification in diabetic white cataract.

To investigate whether Wild Field Imaging System (WFIS SW-8000), 25G endoilluminator, and intraoperative optical coherence tomography (iOCT) can perform real-time screening and diagnosing in patients with suspicious diabetic retinopathy (DR) during phacoemulsification, especially in cases of white cataract. A cross-sectional study was carried out. A total of 204 dense diabetic cataractous eyes of 204 patients with suspected DR treated from April 2020 to March 2021 were included. Phacoemulsification combined with intraocular lens implantation was performed. Following the removal of the lens opacity, the 25G endo-illuminator, fundus photography, and iOCT were performed successively. Optical coherence tomography (OCT) and/or fundus fluorescein angiography (FFA) were used to verify the fundus findings postoperatively. Intraoperative and postoperative results were compared to verify the accuracy of intraoperative diagnosis in each group. Intraoperative and postoperative examinations revealed 58 and 62 eyes with DR, respectively (positive rate, 28.43% and 30.39%, respectively). During the phacoemulsification, WFIS SW-8000 detected 44 eyes with DR (the detection rate, 70.97%); 25G endo-illuminator found 56 eyes with DR (the detection rate, 90.32%); iOCT found 46 eyes with DR (the detection rate, 74.19%); and 58 eyes with DR were found by combining the three methods (the detection rate, 93.55%). There were statistically significant differences in the diagnostic sensitivity for DR among the methods (χ2=16.36, P=0.001). WFIS SW-8000, 25G endo-illuminator, iOCT, and especially their combination can be used to inspect the fundus and detect DR intraoperatively; they are helpful for the timely diagnosis and treatment of DR in patients with dense cataract.

Descemet Membrane Endothelial Keratoplasty in Corneal Endothelial Decompensation After a Forceps-Induced Corneal Birth Injury: Case Series and Technique.

The aim of this study was to describe the efficacy of Descemet membrane endothelial keratoplasty (DMEK) in patients with corneal endothelial decompensation secondary to a forceps-induced corneal birth injury. This was a retrospective, noncomparative, interventional case series. Four eyes of 4 patients (1 female and 3 males; mean age, 64.0 ± 4.7 years) with corneal endothelial decompensation due to forceps-induced corneal birth injury were included. DMEK was performed in all cases, using a combined technique, including the use of intraoperative optical coherence tomography, vital staining of Descemet membrane of both host and donor, removal of scarred Descemet membrane with side-port forceps and vitreous cutter to smoothen the posterior corneal surface, epithelial peeling, and illumination for visualization. The examination included preoperative and postoperative ophthalmologic examinations: best-corrected visual acuity (converted to logarithm of the minimum angle of resolution [logMAR]), intraocular pressure, endothelial cell density (ECD), and central corneal thickness. No postoperative complications were noted, and corneal transparency was maintained during follow-up (mean follow-up period, 32.0 ± 27.0 months; range, 3-71 months). The mean best-corrected visual acuity was 0.52 ± 0.35 logMAR preoperatively and 0.15 ± 0.09 logMAR at the last visit. The mean postoperative ECD was 1632 ± 631 cells/mm 2 (mean ECD at baseline, 3167 cells/mm 2 ). Central corneal thickness decreased from 640 ± 67 μm preoperatively to 576 ± 58 μm postoperatively. This study suggests that DMEK can be performed uneventfully in eyes with a forceps-induced corneal birth injury. The combination of surgical techniques may be an effective approach for DMEK.

Cataract Surgery Combined with Diabetic Vitrectomy and the Use of Intraoperative Optical Coherence Tomography

The cataract develops 2-5 times higher in patients with Diabetes Mellitus (DM) than in the normal population. With the advances in modern surgical equipment and surgical techniques, cataract surgery combined with vitrectomy has become increasingly common among vitreoretinal surgeons. Cataract surgery combined with vitrectomy has its own difficulties. In addition to these difficulties, there are specific situations that should be considered in vitrectomy combined with cataract surgery in patients with DM. Optical Coherence Tomography(OCT) is an imaging method that provides high-resolution sections of ocular tissues. OCT devices integrated into the operating microscope are systems that allow real-time images to be taken during surgery. In this review, vitrectomy combined with cataract surgery and the use of intraoperative OCT in patients with diabetic retinopathy is discussed.

Application of intraoperative optical coherence tomography in deep lamellar keratoplasty

Objective: To evaluate the clinical application value of intraoperative optical coherence tomography (iOCT) in deep anterior lamellar keratoplasty (DALK) using the big-bubble technique to bare Descemet's membrane. Methods: Retrospective case series. Clinical data of 92 patients (92 eyes) with monocular stromal corneal diseases who underwent big-bubble DALK in the Eye Hospital of Shandong First Medical University from January 2020 to August 2021 were collected. There were 53 males and 39 females. The average age was (53.2±16.0) years old. All patients underwent iOCT scanning to determine the location and depth of the injection needle after initial removal of the corneal lesion, to observe the integrity of the recipient bed, Descemet's membrane, after complete lesion removal, and to observe the adhesion between the corneal graft and the recipient bed and check folds on the recipient bed after suturing of the corneal graft. The intraoperative perforation of Descemet's membrane, postoperative thickness of the cornea and the recipient bed, visual acuity, and corneal astigmatism were recorded. Results: By iOCT, the thickness of the recipient bed was found to be about 1/2 of the corneal thickness and relatively uniform in all directions in 62 eyes (67.4%), so the sterile air was injected from the center of the recipient bed to separate it from the stromal layer. In 30 eyes (32.6%) with an uneven thickness of the recipient bed, the sterile air was injected from the paracentral area of the recipient bed. Under the guidance of iOCT scanning, 89 eyes (96.7%) did not experience any perforation of Descemet's membrane during surgery. The Descemet's membrane folds in the central 5-mm area of the recipient bed was observed and flattened in 20 eyes with the assistance of iOCT scanning. The postoperative corneal thickness was (578.95±108.26) μm, and the recipient bed thickness was (36.06±23.11) μm. The best corrected visual acuity of all patients at 6 months after surgery was 0.57±0.25 logMAR, which was significantly better than that before surgery (1.61±1.27 logMAR; P<0.001). The average corneal astigmatism at 6 months after surgery was (2.72±2.44) diopters. Conclusions: The application of iOCT scanning in DALK surgery assisted by the big-bubble method can provide safe guidance for surgeons to adopt correct surgical procedures, decrease the risk of Descemet's membrane perforation, reduce the recipient bed folds, and facilitate corneal interlayer adhesion, thereby improving the visual prognosis.

IOCT-guided simulated subretinal injections: a comparison between manual and robot-assisted techniques in an ex-vivo porcine model

The purpose of this study is to compare robot-assisted and manual subretinal injections in terms of successful subretinal blistering, reflux incidences and damage of the retinal pigment epithelium (RPE). Subretinal injection was simulated on 84 ex-vivo porcine eyes with half of the interventions being carried out manually and the other half by controlling a custom-built robot in a master–slave fashion. After pars plana vitrectomy (PPV), the retinal target spot was determined under a LUMERA 700 microscope with microscope-integrated intraoperative optical coherence tomography (iOCT) RESCAN 700 (Carl Zeiss Meditec, Germany). For injection, a 1 ml syringe filled with perfluorocarbon liquid (PFCL) was tipped with a 40-gauge metal cannula (Incyto Co., Ltd., South Korea). In one set of trials, the needle was attached to the robot’s end joint and maneuvered robotically to the retinal target site. In another set of trials, approaching the retina was performed manually. Intraretinal cannula-tip depth was monitored continuously via iOCT. At sufficient depth, PFCL was injected into the subretinal space. iOCT images and fundus video recordings were used to evaluate the surgical outcome. Robotic injections showed more often successful subretinal blistering (73.7% vs. 61.8%, p > 0.05) and a significantly lower incidence of reflux (23.7% vs. 58.8%, p < 0.01). Although larger tip depths were achieved in successful manual trials, RPE penetration occurred in 10.5% of robotic but in 26.5% of manual cases (p > 0.05). In conclusion, significantly less reflux incidences were achieved with the use of a robot. Furthermore, RPE penetrations occurred less and successful blistering more frequently when performing robotic surgery.

The State of Intraoperative OCT in Vitreoretinal Surgery: Recent Advances and Future Challenges.

Since its first introduction more than 30 years ago, optical coherence tomography (OCT) has revolutionized ophthalmology practice, providing a non-invasive in vivo cross-sectional view of the structures of the eye. Mostly employed in the clinical setting due to its tabletop configuration requiring an upright patient positioning, the recent advent of microscope-integrated systems now allows ophthalmologists to perform real-time intraoperative OCT (iOCT) during vitreoretinal surgical procedures. Numerous studies described various applications of this tool, such as offering surgeons feedback on tissue-instrument interactions in membrane peeling, providing structural images in macular hole repair, and showing residual subretinal fluid or perfluorocarbon in retinal detachment surgery. This narrative review aims at describing the state of the art of iOCT in vitreoretinal procedures, highlighting its modern role and applications in posterior segment surgery, its current limitations, and the future perspectives that may improve the widespread adoption of this technology.

The Role of the Intraoperative Optical Coherence Tomography for Vitreoretinal Surgery in a Real-Life Setting.

To descriptively report the advantages and the feasibility of microscope-integrated intraoperative optical coherence tomography (i-OCT) in managing different vitreoretinal diseases in a real-life setting. We conducted an observational retrospective study involving 265 eyes that underwent elective retinal surgery and intraoperative OCT between 1 September 2018 and 1 October 2022 at Eyecare Clinic (Brescia, Italy). 52 epiretinal membranes, 30 retinal detachments, 60 high myopic eyes, 30 choroidal transplants, 40 macular holes, and 32 vitreo-proliferative retinopathies underwent vitreoretinal surgery and intraoperative OCT scans. The i-OCT was a useful diagnostic exam for all cases and significantly influenced our surgical management. i-OCT is a helpful surgical tool in ophthalmic surgery as it provides real-time feedback of tissue anatomy to surgeons, thereby guiding decision-making. Moreover, it provides additional information on the microarchitectural changes after instrument-tissue interactions, further guiding procedures when necessary and possibly reducing unessential surgical maneuvers.

Quintuple Procedure for Ocular Surface Reconstruction and Visual Rehabilitation.

The aim of this study was to describe a combined surgical approach for ocular surface and visual rehabilitation in patients with limbal stem cell deficiency, corneal scarring, and cataract. We aimed to introduce this combined approach as an alternative to a staged approach and to describe the intraoperative use of a diamond ophthalmic burr (DOB) and optical coherence tomography (OCT) to achieve and confirm a smooth graft-host interface during the anterior lamellar keratoplasty (ALK) portion of the procedure. The quintuple procedure described herein consists of a modified ALK, cataract extraction, intraocular lens implantation, simple limbal epithelial transplantation, and temporal tarsorrhaphy. Intraoperative OCT and DOB were used to guide the creation of the stromal bed during the ALK. The procedure was performed in a patient with limbal stem cell deficiency and corneal scarring after a chemical ocular burn. The tarsorrhaphy was removed at 3 months postoperatively once complete corneal epithelialization was observed. The best-corrected visual acuity improved from light perception preoperatively to 20/30 at 16 months postoperatively with the use of scleral contact lenses. At this postoperative time point, the cornea was clear and compact, and the ocular surface was stable. The quintuple procedure allowed for visual and ocular surface rehabilitation in cases in which follow-up for a staged approach was not possible. Intraoperative OCT allowed for real-time visualization and dissection of the stromal bed, whereas the use of the DOB helped achieve a smooth stromal surface for an optimal graft-host interface.

Intraoperative OCT (iOCT) Guidance for Determining Depth of Lens Grooving and Remaining Lens Thickness From the Posterior Capsule During Phacoemulsification in Cataract Surgery

Purpose: To explore the utility of intraoperative optical coherence tomography (iOCT) in the determination of phacoemulsification groove depth and remaining lens thickness from the posterior capsule before lens cracking. Methods: In this retrospective analysis of 22 eyes, a remaining lens thickness (RLT) of less than 1.5 mm was defined as a suitable remainder to be achieved before initiating lens cracking. Phacoemulsification of the primary groove was carried out to a depth judged to be adequate by assessment of red reflex. An iOCT image was obtained; if the RLT was greater than 1.5 mm, further grooving was performed and a second iOCT measurement was obtained. Once the RLT was 1.5 mm or less, the surgeon proceeded with nucleus cracking. Results: The RLT was less than 1.5 mm in 90.9% of eyes (20/22). In 2 eyes (9.1%), the RLT was greater than 1.5 mm (cataract grade 2 and 5), which prompted further sculpting to deepen the groove. The final RLT was 0.99 and 0.90 mm in these 2 eyes, followed by lens cracking. Conclusions: Quantitative iOCT measurement enabled objective intraocular visualization of cataract groove depth prior to splitting the nucleus. Groove depth judgment using the red reflex resulted in an inadequate depth of grooving and a RLT of greater than 1.5 mm in 9% of eyes, even for an experienced surgeon. Greater difficulty was found in one dense cataract. The iOCT measurement may have helped dictate the need for further grooving before initiating lens cracking, thus minimizing the risk of a difficult or failed lens cracking. Objective confirmation of groove depth will be particularly useful for novice surgeons as they gain experience with the red reflex assessment and could be a helpful adjunct to phacoemulsification training. [ Journal of Refractive Surgery Case Reports. 2023;3(3):e28–e32.

Usefulness of intraoperative optical coherence tomography to minimize the intraocular lens tilt during the intrascleral fixation: a clinical and experimental evaluation

To report the usefulness of intraoperative real-time adjustment of intraocular lens (IOL) tilt during the intrascleral fixation with intraoperative optical coherence tomography (iOCT) as a clinical evaluation and investigate the factors contributing to IOL tilt using iOCT as an experimental evaluation. Retrospective cohort study and experimental research. As a clinical evaluation, the medical records of 43 eyes of 41 patients who underwent intrascleral IOL fixation combined with real-time iOCT observation were retrospectively reviewed. As an experimental evaluation, in order to investigate the factors contributing to IOL tilt, the four experiments were performed using iOCT. The mean IOL tilt angle (°) at the end of surgery and 3 months after surgery were 1.81 ± 1.15 and 2.10 ± 1.66, respectively (p = 0.46). No apparent intra- or postoperative complications occurred during the follow-up period. The experimental evaluation indicated that the IOL tilt was influenced by the insertion angle of the haptic in the vertical direction. The mean IOL tilt angle (°) was 1.94 ± 0.09, 4.67 ± 0.11, 8.90 ± 0.11, and 15.78 ± 0.85 when the insertion angle of the haptic was 0°, 10°, 27.5°, and 45° in the vertical direction, respectively (p < 0.01). Clinical and experimental IOL tilt assessment using iOCT is interactively useful for better quality surgery and better postoperative outcome.

Macular Buckling Surgery Using a Novel L-shaped Buckle for Patients with Myopic Tractional Maculopathy

Purpose: To describe the clinical characteristics and surgical outcomes of patients with myopic tractional maculopathy (MTM) who underwent macular buckling (MB) surgery using a novel L-shaped buckle.Methods: A titanium stent, a style 507 sponge, and a silicone sleeve were used to create an L-shaped macular buckle. The titanium stent was bent through 90° over the last third. The sponge was cut to about 1 cm in length and placed on the extremity. The remaining part of the stent was then covered with a 2-cm-long silicone sleeve; the total buckle length was 3 cm. The buckle was implanted supero-temporally to allow access to the macular region. Intraoperative optical coherence tomography (Zeiss Rescan 700, Carl Zeiss, Jena, Germany) was performed to ensure that the buckle was appropriately positioned.Results: Three patients with MTM underwent MB surgery under general anesthesia. In all patients, the foveae lay at the greatest distances possible from the posterior staphyloma. Given the location of the posterior staphyloma and the posterior scleral expansion, anteroposterior traction was evident in every patient. After surgery, although the extent varied, all patients exhibited reduced anteroposterior traction, evidenced by decreased retinoschisis, staphyloma flattening, and smaller macular holes. In one case, vitrectomy was added to release epiretinal membrane-induced tangential traction. No patient reported any significant ocular complication after surgery.Conclusions: MB using an L-shaped buckle, safely and efficiently relieves anteroposterior traction and improves the macular anatomy in patients with MTM.

Intra-operative optical coherence tomography in corneal lamellar graft reinforcement for Boston type I keratoprosthesis corneal melt.

Corneal melt is a sight-threatening complication of Boston type 1 keratoprosthesis (KPro). Severe corneal melt may result in hypotony, choroidal hemorrhage, and even spontaneous extrusion of the KPro, which may lead to a poor visual prognosis. Lamellar keratoplasty is one surgical option for the management of mild corneal melt, especially when a new KPro is not available. Herein, we present a new surgical technique application, intra-operative optical coherence tomography (iOCT) for the management of cornea graft melt after Boston type 1 KPro implantation. The visual acuity and the intra-ocular maintained stable at 6 months post-operatively, and the KPro remained in place without corneal melting, epithelial ingrowth, or infection. iOCT may prove to be a real-time, non-invasive, and accurate treatment for corneal lamellar dissection and suturing beneath the anterior plate of the KPro, which can effectively help the surgeon to make surgical decisions and reduce post-operative complications.

NOVEL METHOD FOR VISUALIZING PERIPHERAL RETINAL STRUCTURES WITH MICROSCOPE-INTEGRATED OPTICAL COHERENCE TOMOGRAPHY.

Visualization of peripheral retinal structures with optical coherence tomography (OCT) can be challenging but can offer valuable clinical information. We describe a method for intraoperative OCT of the peripheral retina. An investigational microscope-integrated OCT system with real-time 4D volumetric imaging was used in conjunction with a Goldmann style mirrored contact lens intraoperatively to capture peripheral images in three patients. We identified retinoschisis, a retinal break, and areas of focal retinal detachment using our peripheral OCT method. Use of a Goldmann lens in conjunction with intraoperative OCT offers surgeons the ability to resolve peripheral pathology that cannot be easily evaluated with OCT otherwise.

Visualization of surgical maneuvers using intraoperative real-time volumetric optical coherence tomography.

Ophthalmic microsurgery is traditionally performed using stereomicroscopes and requires visualization and manipulation of sub-millimeter tissue structures with limited contrast. Optical coherence tomography (OCT) is a non-invasive imaging modality that can provide high-resolution, depth-resolved cross sections, and has become a valuable tool in clinical practice in ophthalmology. While there has been substantial progress in both research and commercialization efforts to bring OCT imaging into live surgery, its use is still somewhat limited due to factors such as low imaging speed, limited scan configurations, and suboptimal data visualization. In this paper we describe, to the best of our knowledge, the translation of the fastest swept-source intraoperative OCT system with real-time volumetric imaging with stereoscopic data visualization provided via a heads-up display into the operating room. Results from a sampling of human anterior segment and retinal surgeries chosen from 93 human surgeries using the system are shown and the benefits that this mode of intrasurgical OCT imaging provides are discussed.

Cost-effectiveness of the ADVISE trial: An intraoperative OCT protocol in DMEK surgery.

The intraoperative optical coherence tomography (iOCT) is recently introduced in Descemet membrane endothelial keratoplasty (DMEK) surgery, which aims to increase clinical performance and surgery safety. However, the acquisition of this modality is a substantial investment. The objective of this paper is to report on the cost-effectiveness of an iOCT-protocol in DMEK surgery with the Advanced Visualization in Corneal Surgery Evaluation (ADVISE) trial. This cost-effectiveness analysis uses data 6 months postoperatively from the multicentre prospective randomized clinical ADVISE trial. Sixty-five patients were randomized to usual care (n = 33) or the iOCT-protocol (n = 32). Quality-Adjusted Life Years (EQ-5D-5L), Vision-related Quality of Life (NEI-VFQ-25) and self-administered resources questionnaires were administered. Main outcome is the incremental cost-effectiveness ratio (ICER) and sensitivity analyses. The iOCT protocol reports no statistical difference in ICER. For the usual care group compared with the iOCT protocol, respectively, the mean societal costs are €5027 compared with €4920 (Δ€107). The sensitivity analyses report the highest variability on time variables. This economic evaluation learned that there is no added value in quality of life or cost-effectiveness in using the iOCT protocol in DMEK surgery. The variability of cost variables depends on the characteristics of an eye clinic. The added value of iOCT could gain incrementally by increasing surgical efficiency, and aiding in surgical decision-making.

Surgical Tips for Improving Success Rate of Deep Anterior Lamellar Keratoplasty in Keratoconus

This article aims to provide some personal surgical tips to increase the success rate of deep anterior lamellar keratoplasty (DALK), a very advantageous yet complex procedure for treating keratoconus. The most troublesome surgical step is obtaining a successful pneumatic dissection of the deep stromal tissue, allowing the exposure of a deep cleavage plane. The following tips may aid the trainee surgeon in mastering this step, among others: performing a deep trephination, using intraoperative anterior segment optical coherence tomography and/or femtosecond laser, exploiting the red reflex after pupil dilation, using the ophthalmic viscoelastic device in case of bubble formation failure. Approaches for reducing postoperative astigmatism are employing large-diameter grafts and using intraoperative keratoscopy with digital ring analysis. In conclusion, different tips can shorten the DALK learning curve and help to obtain better results from this surgery. Standardizing this surgical technique is paramount to reduce "human errors" and broaden its range of applicability.

Изучение влияния различных методов удаления вискоэластика при факоэмульсификации возрастной катаракты на интраоперационное и раннее послеоперационное состояние интерфейса «интраокулярная линза – капсула хрусталика»

Purpose. To study the effect of various methods of removing ophthalmic viscosurgical device (OVD) in phacoemulsification (PE) of senile cataracts (SC) on intraoperative and early postoperative state of «intraocular lens – posterior lens capsule» (IOL – PLC) interface. Material and methods. Optical coherence tomography (OCT) was performed intraoperative, 2 hours after surgery, on the 1st and 5th days after surgery to study the state of IOL – PLC interface and its parameters in 92 eyes of 92 patients at PE. Results. Intraoperative OCT control showed that when using irrigation and aspiration, full contact IOL – PLC occurred only in 9.8 % of the eyes, after additional impulse-irrigation – in 100 % of the eyes. On the 5th day surgery, significantly better parameters of the IOL – PLC interface (diastasis between the lens and the capsule, size of PLC folds) were detected in the eyes, where IOL pneumocompression was performed as additional method of removing OVD. Conclusion. The study of features of IOL – PLC interface during PE SC and in early postoperative period showed its instability and pronounced variability of the OCT picture. Intraoperative OCT monitoring of state of the IOL – PLC interface revealed greater efficiency of impulseirrigation method in comparison with irrigation and aspiration method in removing OVD from the lens capsule. The use of the method of pneumocompression of the lens capsule made it possible to obtain significantly better indicators of diastasis between the IOL and PLC and the depth of capsule folds 5 days after surgery (p &lt; 0.05). Keywords: phacoemulsification, senile cataract, posterior lens capsule, «intraocular lens – posterior lens capsule» interface

ByLimb: Development of a New Technique to Implant Intracorneal Ring-Segments from the Perilimbal Region.

A new technique that allows implanting intracorneal ring-segments (ICRS) from the limbal zone is described. Using a femtosecond laser (FSL), a 360° corneal tunnel is created with an internal diameter of 5.4 mm and an external diameter of 7.0 mm, with a wider area (0.2 mm inner and 0.2 mm outer) in the upper 60° of the tunnel (called landing zone). Next, a 4.36 mm-long corneal-limbal incision was created with the FSL, which connects to the bubbles created in the landing zone. The entire procedure was performed using intraoperative optical coherence tomography (OCT). Once the two incisions were connected using blunt-edged Mac Pherson forceps, the bubbles were released from the surgical plane. The programmed ICRS(s), 6 mm in diameter, are then placed in the corneal tunnel from the limbal incision with the aid of Sinskey forceps. Finally, when the ICRS is in place, the surgery is complete.

Влияние степени адгезии внутренней пограничной мембраны на результаты хирургии тракционного диабетического макулярного отека

Internal limiting membrane (ILM) peeling is a technically complex manipulation that is performed during macular surgery. Experts'opinions vary on its necessity. Visual inspection during surgery does not always make it possible to assess the degree of ILM adhesion to the retina. The aimof the study was to evaluate the morphofunctional parameters of the macular zone after ILM peeling with different degree of adhesion in the long-term postoperative period. Material and methods. A study was conducted that included 119 patients with type 1 (65 (55%) and type 2 (54 (45%) diabetes mellitus with proliferative stage of diabetic retinopathy (PDR) and tractional diabetic macular edema (tDME). All patients underwent a standard three-port 25G vitrectomy with the use of an additional endo-luminaire «chandelier» and bimanual membrane peeling technique. During ILM peeling, all patients underwent intraoperative optical coherence tomography (I-OCT) in order to assess the degree of ILM adhesion to the retina. Before, 1 and 12 months after the operation, the determination of the maximum corrected visual acuity (MCVA), OCT of the macular zone with the measurement of the central retinal thickness (CRT) was performed. Results and discussion. 3 degrees of adhesion of ILM to the retina were identified with I-OCT during ILM peeling. The degree of ILM adhesion in fovea significantly correlated with the development of a retinal defect in its central area. The development of retinal central zone atrophy showed a significant correlation with a decrease in MCVA 12 months after surgery and with the degree of ILM adhesion to the retina in patients with both types of DM. Conclusions. According to the results of this study, a significant correlation was shown between the degree of ILM adhesion to the retina determined by I-OCT and the risk of macular atrophy, which in turn is associated with low visual functions of patients after tDME surgery with ILM peeling. The resulting principle can be used in surgery of other vitreomacular interface pathologies. Keywords: vitreomacular interface, epiretinal membrane, diabetic macular edema, tractional diabetic macular edema, intraoperative optical coherence tomography, vitreoretinal surgery, proliferative diabetic retinopathy