Endo-OCT as a means to reduce microtraumas of retina in membranectomy

Session Details

Session Title: Free Paper Session 26: Vitreoretinal Surgery VI

Session Date/Time: Sunday 10/09/2017 | 10:00-11:30

Paper Time: 10:24

Venue: Room 116

First Author: : N.Savostianova RUSSIA

Co Author(s): :    V. Salakhutdinov (First Author)   G. Stolyarenko   M. Ledeneva   D. Doroshenko                    

Abstract Details

Purpose:

Membranectomy is critical and one difficult stage of macular surgery. The difficulty is caused by heterogeneity of the adhesion of epiretinal tissue to the retina, and if it is large, microtraumas of the retina appear that are the main cause of loss of visual fields in the postoperative period. Selective surgery, in which the map of adhesion of epiretinal tissue to the retina is created with the help of OCT at the preoperative stage and membranectomy surgery is carried out only in areas of low adhesion, significantly reduces the probability of microtraumas of the retina and other postoperative visual defects.

Setting:

Posterior Eye Segment Diagnostics and Surgery centre, Moscow, Russia

Methods:

The problem is that the OCT does not give quantitative measures of the adhesion. In addition, in the process of vitrectomy and membranectomy, the redistribution of mechanical stress occurs in the epiretinal tissue. Because of this, the topology of the adhesion map changes, and the efficiency of selective surgery decreases. The report presents the results of a study of methods and tools for operational control of the adhesion zones topology in the process of selective surgery. The main attention is paid to the specific application of endo-OCT.

Results:

It is shown that dislocations of the boundaries of high adhesion zones in the process of membranectomy can reach 1.5 mm and with the probability greater than 0.7 are greater than 0.5 mm. It is shown that the use of endo-OCT for the operative control of the adhesion map in the process of selective surgery makes it possible to reduce the probability of falling out of the visual fields by more than 80% in the postoperative period. It is shown that in the overwhelming majority of cases (more than 50%), the onset of membranectomy is accompanied by a microtrauma of the retina, which occurs when the epiretinal tissue is first captured with tweezers. The method of application of endo-OCT is presented that is shown to control the first capture of epiretinal tissue by forceps and gives approximately an order of magnitude decrease in the probability of postoperative complications such as local loss of the photosensitivity retina in the zone of the first capture.

Conclusions:

The efficiency of macular surgery can be increased by approximately an order of magnitude, if in the membranectomy process the boundaries of the adhesion zones are monitored using the endo-OCT.

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