Intraoperative Optical Coherence Tomography-Assisted 27-Gauge Vitrectomy in Eyes with Vitreoretinal Diseases

Abstract

Objective: To report intraoperative optical coherence tomography (iOCT)-assisted 27-gauge microincision vitrectomy surgery (MIVS) in eyes with vitreoretinal disease.

Methods: A retrospective, interventional case series performed at a single center, including 6 eyes with retinal disease that underwent iOCT-assisted 27-gauge MIVS.

Results: The advantages of iOCT were most notable when it was used to evaluate, in real time, different macular areas: the pre-macula, in vitreomacular traction or epiretinal membrane; the intra-macula, in macular edema or macular hole; and the sub-macula, in macular detachment. Real-time imaging and the minimization of shadows cast on the underlying tissues by the 27-gauge instrumentation made it possible to quickly select the best procedure at each critical juncture of the surgery. No patients experienced any complications.

Conclusion: Real-time iOCT imaging during 27-gauge MIVS provided excellent intraoperative visualization of retinal tissues without causing significant obstructions to the surgeon. The positive feedback from the system allowed the surgeon to better judge the necessity of additional surgical procedures.

Keywords: Intraoperative optical coherence tomography; Microincision vitrectomy surgery; Triamcinolone acetonide; Twenty-seven-gauge vitrectomy; Vitreoretinal disease.

Fig. 1

Pairs of images showing the effect of real-time feedback on surgical course in 6 patients. Images were obtained simultaneously with intraoperative surgical photography (left side of each pair) and posterior-segment iOCT (right side of each pair). The green and red lines in the photographs indicate axial and sagittal B-scans in the OCT images, respectively. a Case 2. Vitreomacular traction (VMT) syndrome. The VMT (asterisks) was released, with minimal shadowing (arrowheads) from the 27-gauge instrumentation on the underlying tissues (left image pair). A remnant ERM (arrows) was present, which was removed successfully (left and middle pairs). Finally, no remaining remnant ERM was present (right pair). b Case 3. ERM (lamellar macular hole, MH). An MH was not present before ERM and ILM peeling (left image pair). The ERM (arrow) was carefully peeled with minimal shadowing (arrowheads) from the 27-gauge instrumentation on the underlying tissues (middle pair). Hyperreflective material on the top of the fovea, which appeared as a whitish ring in fundus photography, indicated the presence of triamcinolone particles on the residual ILM, with no post-ERM removal iatrogenic MH (right pair). c Case 4. Macula-on rhegmatogenous retinal detachment (RRD) with vitreous hemorrhage (VH). The VH was removed (left image pair) and the surgeon confirmed that there was no macular detachment (middle pair). RRD repair was performed with confirmation that no macular detachment occurred during fluid-air exchange (FAX) and cryoretinopexy (right pair). d Case 5. Retinal detachment due to MH in a highly myopic eye. An open MH was present before ILM peeling (left image pair). FAX was performed after ILM peeling (middle pair). Subretinal fluid was successfully removed through the MH during and after FAX with minimal shadowing (arrowheads) from the 27-gauge instrumentation on the underlying tissues (right pair). e Case 6. MH after ERM and ILM removal in a highly myopic eye. A relatively large MH was present without an ILM (left image pair). An autologous ILM (arrow) was transplanted from another region with minimal shadowing (arrowheads) from the 27-gauge instrumentation on the underlying tissues (middle pair). Proper placement of the autologous ILM graft in the fovea during and after FAX was confirmed (right pair).