The outcomes and usefulness of Intraoperative Optical Coherence Tomography in vitreoretinal surgery and its impact on surgical decision making

Abstract

Objective. To evaluate the utility of intraoperative OCT and its influence on the surgeon's decision during vitreoretinal surgery. Methods. This was a pilot, prospective case series conducted at a tertiary care ophthalmology department in Lahore, Pakistan. Sixteen patients undergoing vitreoretinal surgeries were included using the Leica Enfocus microscope integrated intraoperative optical coherence tomography (IOCT). We also investigated the changes in surgical decision making based on the findings revealed by IOCT using a questionnaire. Results. 16 patients with a mean age of 40.6 ± 19.0 (range: 11-66) years, were included in the study; one case of acute postoperative endophthalmitis could not be imaged. The surgeon had to modify surgical decisions in four (26.7%) cases. IOCT clearly delineated various tissue planes for efficient and safe surgical dissection in pathologies such as posterior vitreous detachment, vitreomacular traction and epiretinal membranes. Furthermore, it also helped identifying perfluorocarbon-retina interface. Conclusions. The intraoperative OCT modality is a feasible and useful intraoperative imaging technique for various kinds of vitreoretinal disorders. The decision making of the surgeon was modified in a quarter of the cases after the use of this newer modality.

Keywords: Leica Enfocus; intraoperative optical coherence tomography; macular hole; retinal detachment; vitreoretinal surgery.

Fig. 1

(A) Vitreous is still attached temporal to the disc; (B) Vitreous was then detached before closure

Fig. 2

(A) Evidence of subretinal fluid post-surgery without the help of the intraoperative OCT. (B) Re-attached retina post drainage of the subretinal fluid

Fig. 3

(A) Prior to ILM peeling; (B) Post ILM peeling - the paramacular thickness has decreased