Intraoperative use of handheld spectral domain optical coherence tomography imaging in macular surgery

Abstract

Purpose: To describe the intraoperative use of handheld spectral domain optical coherence tomography (SDOCT) imaging in macular surgery.

Design: Prospective, observational case series.

Methods: A handheld SDOCT device was used to obtain preincision optical coherence tomography imaging in patients undergoing vitrectomy for macular diseases. After removal of the internal limiting membrane or the epiretinal membrane, repeat intraoperative imaging was obtained. Spectral domain optical coherence tomography findings were characterized.

Results: An efficient technique was established for obtaining intraoperative SDOCT imaging. A total of eight patients were included in the study. Four patients underwent surgery for macular hole, three patients for epiretinal membrane, and one for vitreomacular traction. Comparison of the preincision and intraoperative SDOCT images demonstrated distinct changes in retinal contour and macular hole configuration. Intraoperative SDOCT imaging identified additional membranes in two patients.

Conclusion: The intraoperative use of handheld SDOCT imaging provides an efficient method for visualizing macular pathology. This technology may, in certain cases, help confirm or identify diseases that may be difficult to visualize during surgery.

Fig. 1

Portable SDOCT workstation.

Fig. 2

Preoperative SDOCT of Case 1 captured immediately before surgery. A, SVP from a 10 × 10-mm volumetric scan outlining the areas scanned in B–D. B, Vertical 10 × 10-mm scan showing a FTMH, cystic thickening of the retina at the hole margin (white arrow), and partial posterior vitreous separation. C, Vertical scan demonstrating partial vitreous separation (red arrow), cystic thickening of the parafoveal region, and normal hyperreflectivity of the ILM before removal. D, Vertical scan demonstrating normal juxtafoveal retinal contour and ILM hyperreflectivity before surgery.

Fig. 3

Intraoperative SDOCT of Case 1 obtained immediately after ILM removal. A, SVP of the areas scanned. The dark spot in the lower right corner is a preretinal hemorrhage. Asterisks show corresponding location on B-scans of B–D. B, Retinal distortion, residual adherent ILM (white arrow), and decreased reflectivity of the outer retina and shadowing (blue arrow) corresponding to a focal hemorrhage at the margin of ILM peeling. This site had a normal retinal contour before surgery. C and D, Note the hyperreflective areas along the inner retinal surface that correspond to the remaining ILM (yellow star). In contrast, there is a less intense hyperreflectivity in the areas in which the ILM was peeled corresponding to the nerve fiber layer.

Fig. 4

Spectral domain optical coherence tomography of Patient 7. A, Diffuse epiretinal membrane with focal area of discontinuity. Note multiple thin strands between the retinal surface and the membrane (white arrow). B, Irregular retinal contour with release of attachments after membrane peeling. C, SVP of preincision scan showing normal vessel appearance. D, SVP of preincision scan showing motion artifact and a broken vascular pattern.

Fig. 5

Comparison of the preoperative and intraoperative SDOCT of Patient 1 demonstrating change in the MH configuration. A, Preoperative image demonstrating a FTMH and cystic retinal thickening. The red lines depict the MH height and the base diameter. B, Postoperative scan showing a more peaked appearance of the hole edge and a smaller base diameter. Also, note the distinction of the hyperreflectivity along the retinal surface in the area with remaining ILM (white arrow) compared with the adjacent retina in which the ILM was removed.

Fig. 6

Spectral domain optical coherence tomography of Patient 2 captured preoperatively and after initial and complete ILM removal. A, SVP from a 5 × 5-mm volumetric scan. B, Preoperative image showing a FTMH in an area of perifoveal geographic atrophy. C, Intraoperative images obtained after initial ILM removal show a “scrolled,” partially separated ILM at the margin of the MH. Note the difference in retinal contour at the right side of the hole where the ILM is now absent compared with the left margin where the ILM persists. The red line depicts the maximum hole diameter. D, OCT scan after complete ILM removal shows a more elevated and less taut retinal morphology compared with previous scans with the MH approaching closure.

Fig. 7

Spectral domain optical coherence tomography of Patient 6. A, Epiretinal membrane with multiple attachments (white arrows) and traction. Note the corrugated retinal appearance between the attachments and the hyperreflective opacities anterior to the membrane. B, Decreased retinal traction after membrane peel (white arrows) with normalization of the retinal contour.

Fig. 8

A, Preincision 5 × 5-mm SDOCT scan of Patient 8 demonstrating vitreomacular traction with cystic thickening of the retina. The white arrow demonstrates the attachment of the hyaloid to the fovea. B, Intraoperative 5 × 5-mm SDOCT scan showing the edge of the peeled hyaloid (white arrow). The hyperreflective spots along the retinal surface likely represent residual triamcinolone particles.