Multicolor Scanning Laser Ophthalmoscopy Strengthens Surgeons' Preoperative Decision-Making and Intraoperative Performance on Epiretinal Membrane

Abstract

Purpose: To determine whether multicolor scanning laser ophthalmoscopy (MC-SLO) was better than color fundus photography (CFP) to enhance residents and specialists' preoperative decision-making and intraoperative performance on the epiretinal membrane (ERM).

Methods: Consecutive patients with idiopathic ERM were recruited prospectively. All the patients underwent MC-SLO and CFP imagings and were randomized into MC-SLO (n = 20) and CFP (n = 20) groups. Preoperatively, residents and specialists were required to have ERM delineation and select an optimal location for initial ERM peeling independently, based on the MC-SLO (MC-SLO group) or CFP (CFP group) images. Intraoperative optical coherence tomography (iOCT) was introduced to evaluate the accuracy.

Results: Preoperatively, residents and specialists acted more effectively in ERM delineation and selection of initial grasping location in the MC-SLO group (both P < 0.001). In the MC-SLO group, higher resident-specialist agreements were achieved in ERM delineation (P = 0.002) and selection of initial grasping location (P = 0.035). The iOCT revealed greater interobserver (iOCT-resident and iOCT-specialist) agreements of ERM delineation in MC-SLO group (P < 0.001 and = 0.027, respectively). Surgeons acted more effectively on completely peeling the ERM in the MC-SLO group (P < 0.001).

Conclusions: MC-SLO provided a better visual reference for residents and specialists in ERM delineation and the selection of an initial grasping location for the surgery, compared with CFP.

Translational relevance: MC-SLO is able to help surgeons achieve better intraoperative performance and shorten the learning process for residents.

Keywords: color fundus photography; epiretinal membrane; intraoperative optical coherence tomography; multicolor scanning laser ophthalmoscopy; pars plana vitrectomy.

Figure 1.

Flowchart of the study. Eligible patients were randomized into MC-SLO and CFP groups. Preoperatively, residents and specialists delineated the ERM margins and select the initial grasping location in both MC-SLO and CFP groups, and were graded for resident–specialist agreement. Intraoperatively, assessments were made with iOCT for the iOCT–resident and iOCT–specialist agreement on ERM delineation, accuracy of initial grasping location, and surgical performance.

Figure 2.

Representative case on how to have preoperative decision making of ERM demarcation in the MC-SLO group (A) and the CFP group (B). The residents and experienced surgeons were required to have delineation of the whole ERM margin based on the MC-SLO and CFP images (white lines in A and B). (C) OCT image required when having MC-SLO imaging supported the definite diagnosis of ERM (white arrows) in the patient.

Figure 3.

Representative case on how to have preoperative decision making of where to start the initial membrane peeling in the MC-SLO group (A) and the CFP group (B). The residents and experienced surgeons were required to decide where they considered the easiest to create the free edge for complete ERM peeling (white arrows in A and B). (C) OCT images were acquired when having MC-SLO imaging revealed the ERM margins (white arrows).

Figure 4.

Representative case on how to have intraoperative agreement assessment in the MC-SLO group (A) and the CFP group (B). All the fundus photographs (A1, B1, and C1) have been rotated 180° to appear the same with the surgeons’ viewing under microscope when performing the ERM surgery. (A) In the MC-SLO group, the location to have initial peeling has been pointed out preoperatively (white arrow in A1), iOCT imaging revealed the selected location was true, as there was more remarkable and obvious elevation of the retina's inner surface (white arrows in A2). (B) In the CFP group, the location to have peeling has been pointed out preoperatively (white arrows in B1), iOCT imaging revealed the selected location was false, as there was no remarkable and obvious elevation of the retina's inner surface. (C) MC-SLO image taken 1 day postoperatively (C1) and iOCT imaging taken intraoperatively (C2) revealed complete peeling off of the ERM (arrows in C2).