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En face SD-OCT details retinal morphology after ILM peeling
En face spectral-domain optical coherence tomography was found to be successful in imaging the macular surface before and after internal limiting membrane peeling for epiretinal membrane, according to a study.
“En face spectral domain optical coherence tomography of the retinal surface is an interesting complement to standard retinal optical coherence tomography section that provides an easy-to-understand global overview of the retinal surface. It can detect and classify tiny progressive morphologic changes in the texture of the retinal surface occurring after internal limiting membrane peeling,” the study authors said.
Investigators retrospectively analyzed preoperative and postoperative en face spectral-domain OCT (SD-OCT) images of the inner face of the macula obtained in 20 eyes of 20 patients undergoing vitrectomy with internal limiting membrane peeling for epiretinal membrane ERM.
Postop ophthalmic examinations were performed at 1, 2, 8, 15 and 45 days, and subsequently every 3 months. OCT images were obtained 2 to 4 weeks postoperatively, at 3 months and 6 months when possible, and subsequently every 6 months.
Study results showed that preop en face SD-OCT images revealed single or multiple plaques surrounded by radiating retinal folds. The plaques coincided with areas of retinal adherence of the membrane and/or posterior hyaloid. Folds correlated with a serrated pattern of the inner retinal face that was associated with a localized detachment of the membrane.
Dimples of the retinal surface were identified in the final en face SD-OCT examination for 13 eyes (87%).
En face SD-OCT showed dimples increasing in number and size during postop follow-up. Arcuate lines were identified in the peeled area in three eyes (15%), the authors said.
Perspective
Back to TopThe understanding of the vitreomacular relationship in various diseases had been advanced more in the last decade than in the history of ophthalmology. A major contributor is the advance in imaging technology. In recent years, spectral domain OCT has shown us that vitreo-macular adhesion (VMA) may play an important role not only in vitreomacular traction syndrome, macular hole, epiretinal membrane … but also in diabetic macular edema, neovascular macular degeneration, retinal vein occlusion, etc. In other words, the potential impact of understanding and then treating VMA is enormous. The timing is particularly propitious, as major advances have occurred in microincisional vitrectomy surgery in the past 5 years, and a pharmacologic vitreolytic drug, ocriplasmin (Jetrea, ThromboGenics), has been approved by the FDA.
In this context, this paper describes a major advance in imaging VMA. En face technology will allow a more detailed three dimensional image of VMA in disease initiation, progression and resolution. Are certain areas of adhesion more likely to induce symptoms? Neovascularization? Edema? How does VMA resolve? Does it pop off or does it slowly peel off? Does this affect visual function? Is surgical VMA release different from pharmaceutical VMA release? Are some surgical dyes harmful? Are they necessary with this technology? What is the natural course of “dimples”, “craters”, dissociated optic nerve fiber layer? Are they harmful? Do they resolve? What do they represent? The answers to these and many other germane questions will be facilitated by en face OCT … and this will be a major contribution to understanding and treating VMA in a vast number of retinal diseases.