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Observational Study
. 2024 Mar 5;14(1):5393.
doi: 10.1038/s41598-024-56125-y.

Clinical significance of signal shadowing during intraoperative optical coherence tomography-assisted vitreoretinal surgery

Erick Carlos Reyna  1 , Melisa Öztek  2 , Goran Petrovski  3   4   5   6 , Susanne Binder  7   8 , Knut Stieger  2 , Lyubomyr Lytvynchuk  2   7
Affiliations
Observational Study

Clinical significance of signal shadowing during intraoperative optical coherence tomography-assisted vitreoretinal surgery

Erick Carlos Reyna et al. Sci Rep. .

Abstract

This study aimed to analyze the clinical significance of signal shadowing during intraoperative optical coherence tomography (iOCT)-assisted vitreoretinal surgery caused by vitreoretinal instruments, tissue dyes, and vitreous substitutes, and to objectively quantify its impact on iOCT imaging. This is a retrospective observational study of postoperative image analysis from one hundred seventeen (117) patients who underwent iOCT-assisted vitrectomy. The image data were divided into three groups: vitreoretinal instruments, tissue dyes, and vitreous substitutes. The data was then processed using graphic software to measure the grade of picture quality distortion and compared to paired image controls without clinically perceptive interference, then analyzed statistically. The intraocular portion of all studied vitreoretinal instruments caused a high average gray level interference compared to controls ranging from 32 to 68% reduction, obscuring the area of interest significantly. The tips of the instruments produced low-grade shadowing, allowing the underlying tissue to be distinguished. The analyzed dyes demonstrated a wide interference range: ICG (- 75.12%), and triamcinolone (- 26.13%) showed dose-dependent high shadowing, while VITREODYNE™ (49.3%) and brilliant blue G (14.06%) exhibited no perceived distortions whilst increasing average gray levels. All analyzed vitreous substitutes (air, SF6, C3F8, PFCL, and silicone oil) showed an insignificant shadowing effect on iOCT. Certain dyes and vitreous substitutes produce a negligible shadowing effect compared to controls and other dyes, providing an advantage during real-time iOCT imaging. All analyzed vitreoretinal instruments showed a significant interference that should prompt the development of new imaging techniques or the implementation of materials with low-grade interference to overcome a clinically relevant shadowing effect on iOCT, maximizing the technology's visual accuracy and surgical diagnostic aid proficiency.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Histogram analysis comparison examples between controls (left) and study images (right) with noticeable shadowing effect of the analyzed tools: (a) Vitrectome. (b) ILM forceps. (c) Silicone tipped cannula. (d) Finesse® Flex Loop. (e) Tano Diamond Dusted Membrane Scraper.
Figure 2
Figure 2
Histogram analysis comparison examples between controls (left) and study images (right) of the analyzed stains: (a) Indocyanine green. (b) Brilliant blue G. (c) Triamcinolone acetonide. (d) Lutein-based dye VITREODYNE™.
Figure 3
Figure 3
Histogram analysis examples of the vitreous substitutes analyzed: (a) BSS (control). (b) Air. (c) SF6. (d) C3F8. (e) PFCL. (f) Silicone oil.
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