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Intra-operative SD-OCT use in surgical management of submacular hemorrhage with subretinal tissue plasminogen activator

Session Details

Session Title: FP-16 Vitreoretinal Surgery IV

Session Date/Time: Sunday 14/09/2014 | 11:00-13:00

Paper Time: 11:08

Venue: Boulevard D

First Author: : B.Dupas FRANCE

Co Author(s): :    P.R. Rothschild   S. Chahed   P. Massin   R. Tadayoni     

Abstract Details

Purpose:

To illustrate how the use of a new device allowing the acquisition of high resolution intraoperative Spectral Domain Optical Coherence Tomography (SD-OCT) images of the posterior segment in real time, can help performing and understanding surgical procedure.

Setting:

Ophthalmology Department, Lariboisière Hospital, Paris, France

Methods:

Intra-operative SD-OCT (LUMERA 700 with OCT RESCAN 700, Carl Zeiss Meditec) was used. It enables the application of OCT functionality to an ophthalmic surgical microscope and provides OCT image data to an assistance system. OCT images are showed on a screen and visible by the surgeon in real-time. Videos from three surgical cases of submacular haemorrhages related to age related macular degeneration will be showed. For each case, 25-gauge pars plana vitrectomy was performed. Tissue plasminogen activator (TPA) was injected transretinally into the subretinal space using a 41-gauge cannula (De Juan/Awh Subretinal Injection, Synergetics) mounted on a 10 ml syringe connected to an active injection device. Cannula was put close to the retina, in an area of subretinal haemorrage, but without puncture or penetration into the subretinal space. SD-OCT high definition raster scans and cube were performed intra-operatively at the site of injection, in order to screen for any retinal break. SF6 was injected at the end of the procedure.

Results:

Intra-operative and post operative careful SD-OCT scans review did not show any retinal hole at the site of TPA injection or next to it.

Conclusions:

Subretinal injection of tissue plasminogen activator with a 41-gauge cannula does not seem to induce full thickness retinal hole. A transient stretching of retinal cells, induced by the TPA flow, may be invoked. ILM peeling may favor the entry of TPA through the retina.

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