Intraoperative OCT may affect decisions made during vitreomacular traction surgery

Building the OCT system into the microscope may allow better visualization of the traction, researcher says.

Issue: October 25, 2014

Subclinical findings seen on intraoperative optical coherence tomography during vitreomacular traction surgery may affect decision making, according to a study.

“There are definitely things in surgery that we may not be able to perceive with a standard operating microscope. OCT may provide us with information that we were otherwise not able to identify under standard operating conditions,” Justis P. Ehlers, MD, told Ocular Surgery News.

Justis P. Ehlers

The study published in Retina suggested that intraoperative optical coherence tomography (iOCT) provides insights that may affect surgical decision making, but it needs to be studied on a larger scale.

“I think that preliminary data that was generated from our study suggested that OCT information may change the way we surgically approach the condition,” Ehlers said.

Methods

The retrospective, consecutive case series included 12 eyes of 12 patients who underwent three-port pars plana vitrectomy repair of vitreomacular traction. Eleven eyes underwent 23-gauge pars plana vitrectomy, and one eye underwent 25-gauge pars plana vitrectomy. Before surgery, all patients were scanned with Cirrus spectral-domain OCT (Carl Zeiss Meditec).

“The gold standard for an interventional research study is having a masked randomized controlled trial, and those are very challenging with intraoperative OCT or with any surgical procedure,” Ehlers said. “However, we are currently working on designing those trials for the future.”

Researchers completed a quantitative analysis on the iOCT scans to review subretinal hyporeflectivity and central foveal thickness.

Results

Mean visual acuity improved from 20/72 to 20/51, and mean central foveal thickness decreased from 797 µm at the start of surgery to 694 µm after hyaloid release.

On iOCT, all eyes showed clearance of tractional forces surrounding the fovea.

In five eyes, the iOCT findings affected decision making during the surgical procedure to address subclinical findings such as full-thickness macular hole formation and/or residual membrane.

“Newer systems, such as a microscope-integrated OCT, may allow the surgeon to directly visualize release of the traction on OCT and visualize when traction has exceeded a certain level,” Ehlers said. “That may provide additional information and enhance our surgical approach even more.” – by Nhu Te

Reference:

Ehlers JP, et al. Retina. 2014;doi:10.1097/IAE.0000000000000123.

For more information:

Justis P. Ehlers, MD, can be reached at Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave./i32, Cleveland, OH 44195; email: ehlersj@ccf.org.
Disclosure: Ehlers is a consultant for Zeiss, Leica, Bioptigen and ThromboGenics, receives research support (grant) from ThromboGenics, receives research support (equipment) from Bioptigen, Zeiss and Surgical One, and has intellectual property with Bioptigen and Synergetics.