Session Title: FP-16 Vitreoretinal Surgery IV
Session Date/Time: Sunday 14/09/2014 | 11:00-13:00
Paper Time: 12:36
Venue: Boulevard D
First Author: : S.Kusaka JAPAN
Co Author(s): : K. Tachibana Y. Shimomura
To investigate the usefulness of real-time intraoperative high-definition optical coherence tomography (HD-OCT) during vitrectomy for retinal detachments using a HD-OCT integrated surgical microscope.
Retrospective, noncomparative, interventional case series.
In 8 eyes of 8 patients (4 women and 4 men) with a retinal detachment, vitrectomy was performed with a surgical microscope (Rescan 700; Carl Zeiss Meditec, Oberkochen, Germany) in which a HD-OCT (CirrusTM) was integrated with Lumera® 700. The ages of the patients ranged from 4 to 68 years with a median of 43.5 years. The cause of the retinal detachments included idiopathic (4 eyes), atopic dermatitis (1 eye), familial exudative vitreoretinopathy (1 eye), morning glory syndrome (1 eye), and trauma (1 eye). Before the surgery, the macula was detached in 6 eyes, and 5 received perfluoro-n-octane (PFO) to displace the subretinal fluid (SRF) peripherally. After fluid/air exchange, the fluid above PFO was aspirated followed by SRF aspiration from the original retinal breaks to prevent migration of SRF beneath the macula. During vitrectomy, real-time HD-OCT images were taken and evaluated.
In all eyes, clear HD-OCT images were obtained under fluid or air. In the 6 eyes in which the macula had been detached before surgery, a loss of the foveal depression was seen under fluid or air. In 5 of these 6 eyes in which PFO had been used, SRF was still present under the macula after fluid/air exchange despite the effort to prevent SRF from seeping under the macula. In one eye in which a retinal break had been located in the posterior retina, no SRF was present beneath the macula after air irrigation.
Clear, real-time HD-OCT images can be obtained with the Rescan 700 during vitrectomy for retinal detachment of various etiologies. The failure to prevent SRF from seeping beneath the macula suggests that improvement of surgical technique is necessary. Further studies are needed to establish the optimal treatment of macula-off retinal detachment based on the intraoperative OCT findings.