Intraoperative OCT enhances safety, accuracy of peeling surgery

Issue: July 10, 2015

VIENNA — Intraoperative OCT has the potential to make peeling surgery easier and safer, offering real-time visualization of surgical maneuvers and iatrogenic effects of peeling-associated traction, according to one surgeon.

In a study set up by the group of Oliver Findl, MD, at Hanusch Hospital in Vienna, the Rescan 700 OCT system (Carl Zeiss Meditec) was used during 23-gauge pars plana vitrectomy with membrane peeling in 20 patients.

The epiretinal membrane was visible with the OCT in all patients. ERM remnants in the perifoveal region were detected after the first peeling attempt in 40% of the eyes.

“This was useful information that we would have missed without intraoperative OCT,” Christoph Leisser, MD, said at the meeting of the European Society of Ophthalmology.

However, neither the internal limiting membrane nor the posterior hyaloid were visible with the OCT in any of the patients, he said.

Another interesting finding was related to subfoveal hyporeflective zones, which were shown to be induced by iatrogenic traction in 13% of the cases. Other cases (8%) were postoperative independent entities.

“Complete reabsorption occurred spontaneously within 2 to 4 days in all the cases,” Leisser said.

He noted that intraoperative OCT imaging has not yet reached the quality of standalone OCT and needs further improvement. However, users of this technology report better surgical control, increased safety and better results.

“You can perform peeling without staining, avoiding the toxic effects of dyes on the retina, though staining will still be necessary when ILM peeling is involved. Exact localization of the ERM detached areas makes your surgery more accurate and less traumatic, and you can assess whether the peeling is complete or not,” he said. – by Michela Cimberle

Disclosure: Leisser reports no relevant financial disclosures. Findl reports he is a consultant to Carl Zeiss Meditec.