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Intraoperative OCT-Assisted Subretinal Perfluorocarbon Liquid Removal in the DISCOVER Study.

ABSTRACT: To assess the role for intraoperative optical coherence tomography (iOCT) during subretinal perfluoro-n-octane (PFO) removal and evaluate it as an assistive technique during surgical maneuvers.DISCOVER is a prospective study examining microscope-integrated iOCT systems in ophthalmic surgery. The authors report a technique utilizing iOCT guidance and feedback for surgical removal of chronic subretinal PFO.In this technique, real-time iOCT feedback successfully guided surgical maneuvers to facilitate removal of PFO. Due to the chronicity of the PFO, it was loculated and resistant to multiple maneuvers. Utilizing real-time feedback, additional maneuvers were attempted with feedback to the surgeon regarding the success of removal. Postoperatively, visual acuity improved with anatomic normalization.Microscope-integrated iOCT with real-time feedback provided important information to the surgeon that helped facilitate subretinal PFO removal and guided surgical maneuvers.

SUBMITTER: Smith AG

PROVIDER: S-EPMC4915964 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Intraoperative OCT-Assisted Subretinal Perfluorocarbon Liquid Removal in the DISCOVER Study.

Smith Adiel G AG Cost Brian M BM Ehlers Justis P JP

Ophthalmic surgery, lasers & imaging retina 20151001 9

<h4>Background and objective</h4>To assess the role for intraoperative optical coherence tomography (iOCT) during subretinal perfluoro-n-octane (PFO) removal and evaluate it as an assistive technique during surgical maneuvers.<h4>Materials and methods</h4>DISCOVER is a prospective study examining microscope-integrated iOCT systems in ophthalmic surgery. The authors report a technique utilizing iOCT guidance and feedback for surgical removal of chronic subretinal PFO.<h4>Results</h4>In this techn ...[more]

PMID: 26469237

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Project description:PurposeTo assess the retinal architecture changes which occur during epiretinal membrane (ERM) surgery, utilizing intraoperative optical coherence tomography (iOCT).DesignProspective multi-surgeon single center study.Subjects/participantsSubjects from the PIONEER iOCT study who underwent surgical intervention for management of ERM.MethodsAll subjects underwent vitrectomy with ERM peeling with optional internal limiting membrane (ILM) peeling. Preoperative, intraoperative, and postoperative quantitative and qualitative OCT assessments were performed. Clinical characteristics including visual acuity outcomes, central subfield thickness and complications including ERM recurrence and need for reoperation were assessed at 3, 6 and 12 months following surgery for membrane peeling, as available.Main outcome measuresVisual acuity outcomes, anatomic outcomes and complications including ERM recurrence. Microarchitectural alterations (i.e. retinal layer changes) following membrane peeling visualized with iOCT.ResultsSeventy-six were identified and included in this analysis of clinical outcomes and quantitative OCT assessment. Twenty-four eyes were excluded due to insufficient intraoperative OCT quality for quantitative assessment. The mean preoperative VA measured 20/63. The mean postoperative VA at 3 months was 20/41 (p<0.0001), at 6 months measured 20/36 (p < 0.0001), and at 12 months measured 20/33 (p < 0.0001). Preoperative mean central subfield thickness (CST) was 426 microns. At 3 months, the mean CST improved to 377 microns (p < 0.0001). The 6-month postoperative CST was 367 microns (p < 0.0001) and the 12-month postoperative CST measured 359 microns (p < 0.0001). Immediately following membrane peeling, the distance between the retinal pigment epithelium and the ellipsoid zone as well as the distance between the retinal pigment epithelium and the cone outer segment tips/interdigitation zone significantly increased (p < 0.001). iOCT identified occult residual membranes in 12% of cases and confirmed complete membrane peeling contrary to surgeon impression in 9% of cases. Reoperation was required for recurrent ERM in 1% of eyes.ConclusionsiOCT-assisted ERM peeling resulted in significant improvement in visual acuity, reduction in macular thickness, and low recurrence rate. Additional research is needed with randomized clinical trials to better define the comparative success rates of image-guided ERM surgery to standard surgical visualization techniques.

Project description:PURPOSE:To report the 3-year assessment of feasibility and usefulness of microscope-integrated intraoperative OCT (iOCT) during ophthalmic surgery. DESIGN:Prospective, consecutive case series. PARTICIPANTS:Adult participants undergoing incisional ophthalmic surgery with iOCT imaging who consented to be enrolled in the Determination of Feasibility of Intraoperative Spectral-Domain Microscope Combined/Integrated OCT Visualization during En Face Retinal and Ophthalmic Surgery (DISCOVER) study. METHODS:The DISCOVER study is a single-site, multisurgeon, institutional review board-approved investigational device prospective study. Participants included patients undergoing anterior or posterior segment surgery who underwent iOCT imaging with 1 of 3 prototype microscope-integrated iOCT systems (i.e., Zeiss Rescan 700, Leica EnFocus, or Cole Eye iOCT systems). Clinical characteristics were documented, iOCT was directed by the operating surgeon at predetermined surgical time points, and each surgeon completed a questionnaire after surgery to evaluate the usefulness of iOCT during surgery. MAIN OUTCOME MEASURES:Feasibility of iOCT based ability to obtain an OCT image during surgery and usefulness of iOCT based on surgeon reporting during surgery. RESULTS:Eight hundred thirty-seven eyes (244 anterior segment cases and 593 posterior segment cases) were enrolled in the DISCOVER study. Intraoperative OCT demonstrated feasibility with successful image acquisition in 820 eyes (98.0%; 95% confidence interval [CI], 96.8%-98.8%). In 106 anterior segment cases (43.4%; 95% CI, 37.1%-49.9%), the surgeons indicated that the iOCT information impacted their surgical decision making and altered the procedure. In posterior segment procedures, surgeons reported that iOCT enabled altered surgical decision making during the procedure in 173 cases (29.2%; 95% CI, 25.5%-33.0%). CONCLUSIONS:The DISCOVER iOCT study demonstrated both generalized feasibility and usefulness based on the surgeon-reported impact on surgical decision making. This large-scale study confirmed similar findings from other studies on the potential value and impact of iOCT on ophthalmic surgery.

Project description:PurposeWe report a case of old submacular hemorrhage (SMH) due to polypoidal choroidal vasculopathy (PCV). Subretinal endoscopic surgery (SES) was performed, which improved visual function. In addition, we show the intraoperative findings of subretinal aberrant PCV vessels as seen under endoscopic observation, which cannot be observed by microscopic surgery.ObservationsA 71-year-old Japanese man presented with an old dehemoglobinized SMH due to PCV in his left eye. At the time of presentation, three weeks had already passed after the onset of the patient's symptoms, and the best-corrected visual acuity (BCVA) was 20/200. SES was performed to remove the SMH and treat the subretinal PCV lesions. After creating retinal detachment using a 38-gauge cannula, three subretinal 25-gauge trocars were inserted from the sclera to the subretinal space. Then, SES was performed under ophthalmic endoscopic observation with continued subretinal irrigation for maintaining the retinal detachment. After removal of the SMH, subretinal polyp-shaped nodular vascular lesions (polyps) and a branching vascular network, which is located inside the retinal pigmented epithelium, were identified. The sites that presumably originated from the aberrant vessels of the PCV and the associated polyps were coagulated using endodiathermy. After the subretinal procedure, the retina was flattened with fluid/air exchange, and silicone oil (SO) was injected into the vitreous cavity. The SMH completely disappeared after surgery. Although at one-month follow-up BCVA (20/250) was slightly worse than that before surgery, there was an improvement in postoperative retinal sensitivity in the macula compared to that before surgery. At the three-month follow-up, the SO was removed. The BCVA was 20/200 one month after SO removal. No postoperative complications occurred. Additional treatment was not required, including anti-vascular endothelial growth factor therapy, for PCV progression or SMH recurrence in the left eye till the final visit two years after surgery.Conclusion and importanceSES could effectively remove the old SMH, and the activity of PCV was suppressed by intraoperative subretinal coagulation. The retinal sensitivity of the macula improved after the SES. In addition, we observed subretinal polyps and a branching vascular network located internal to the retinal pigmented epithelium under intraoperative subretinal endoscopic observation. SES is a good surgical option for the removal of old SMH or treatment of subretinal lesions.

Dataset Information

Intraoperative OCT-Assisted Subretinal Perfluorocarbon Liquid Removal in the DISCOVER Study.

Publications

Intraoperative OCT-Assisted Subretinal Perfluorocarbon Liquid Removal in the DISCOVER Study.

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