Dataset Information

Outcomes of Intraoperative OCT-Assisted Epiretinal Membrane Surgery from the PIONEER Study.

ABSTRACT: Purpose:To assess the retinal architecture changes which occur during epiretinal membrane (ERM) surgery, utilizing intraoperative optical coherence tomography (iOCT). Design:Prospective multi-surgeon single center study. Subjects/Participants:Subjects from the PIONEER iOCT study who underwent surgical intervention for management of ERM. Methods:All 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 measures:Visual acuity outcomes, anatomic outcomes and complications including ERM recurrence. Microarchitectural alterations (i.e. retinal layer changes) following membrane peeling visualized with iOCT. Results:Seventy-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. Conclusions:iOCT-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.

SUBMITTER: Ehlers JP

PROVIDER: S-EPMC5891156 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Outcomes of Intraoperative OCT-Assisted Epiretinal Membrane Surgery from the PIONEER Study.

Ehlers Justis P JP Khan Mehnaz M Petkovsek Daniel D Stiegel Laura L Kaiser Peter K PK Singh Rishi P RP Reese Jamie L JL Srivastava Sunil K SK

Ophthalmology. Retina 20180401 4

<h4>Purpose</h4>To assess the retinal architecture changes which occur during epiretinal membrane (ERM) surgery, utilizing intraoperative optical coherence tomography (<i>i</i>OCT).<h4>Design</h4>Prospective multi-surgeon single center study.<h4>Subjects/participants</h4>Subjects from the PIONEER <i>i</i>OCT study who underwent surgical intervention for management of ERM.<h4>Methods</h4>All subjects underwent vitrectomy with ERM peeling with optional internal limiting membrane (ILM) peeling. Pre ...[more]

PMID: 29651467

Similar Datasets

Project description:Importance:Primary epiretinal membrane (ERM) is a common retinal disorder with a prevalence of 4% to 18.5%. Although ERM and cataracts commonly occur together, to our knowledge, no studies have investigated the outcome of cataract surgery alone in this setting. Objective:To analyze the visual outcome and cystoid macular edema risk with cataract surgery in eyes with primary ERM. Design, Setting, and Participants:In this retrospective clinical database study, data were collected from July 2003 to March 2015 from 8 locations in the United Kingdom. Cataract surgery data of 217?557 eyes were extracted from the electronic medical record of the UK National Health Service. After exclusion of 57?561 eyes with combined surgery, prior vitrectomy, copathology, and complications, 812 eyes with primary ERM and 159?184 reference eyes were analyzed. Main Outcomes and Measures:We report on visual acuity (VA), the incidence of cystoid macular edema, and the need for ERM surgery. Results:The mean (SD) age of patients in the ERM group was 73.7 (9.23) years, and 395 of 812 were men (46.8%). The mean (SD) age of patients in the reference group was 74.4 (12.19) years, and 65?265 of 159?184 were men (41%). Epiretinal membrane eyes assessed at 4 to 12 weeks postoperatively gained 0.27 (0.32) logMAR (approximately?3 Snellen lines), with 200 of 448 (44.6%) improving by 0.30 logMAR or more (?3 Snellen lines) and 32 of 448 (7.1%) worsening by 0.30 logMAR or more. Reference eyes gained a mean (SD) of 0.44 (0.26) logMAR (approximately?4 Snellen lines), with 48?583 of 77?408 (62.8%) improving by 0.30 logMAR or more and 2125 of 77?408 (2.7%) worsening by 0.30 logMAR or more. Although all eyes with preoperative VA of 20/40 or less improved, only reference eyes with preoperative VA of more than 20/40 showed improvement. Cystoid macular edema developed in 57 of 663 ERM eyes (8.6%) (95% CI, 6.69-10.98) and 1731 of 125?435 reference eyes (1.38%) (95% CI, 1.32-1.45) (P?<?.001). Epiretinal membrane surgery was performed in 43 of 663 (6.5%) ERM eyes. Conclusions and Relevance:On average, VA improved 0.27 logMAR (approximately 3 Snellen lines) in eyes with ERM. Eyes with ERM and VA of 20/40 or less showed more benefit after cataract surgery than those with better preoperative vision. However, compared with eyes without ERM, higher rates of cystoid macular edema and a lower postoperative VA gain were noted.

Project description:PurposeTo correlate intraoperative interface fluid dynamics during Descemet stripping automated endothelial keratoplasty (DSAEK) using intraoperative optical coherence tomography (iOCT) in the Prospective Intraoperative and Perioperative Ophthalmic Imaging with Optical Coherence Tomography (PIONEER) study with postoperative outcomes.DesignProspective consecutive, interventional, comparative case series.ParticipantsOne hundred seventy-eight eyes of 173 patients undergoing DSAEK from the Cole Eye Institute, Cleveland, Ohio.MethodsEyes that underwent DSAEK between October 2011 and March 2014 from the PIONEER intraoperative and perioperative OCT study were included. An automated interface fluid segmentation algorithm evaluated intraoperative dynamics of interface fluid before and after surgical manipulations. iOCT images were also captured at multiple intraoperative time points for 2 different DSAEK techniques, 1 that used an active air infusion system and 1 that did not.Main outcome measuresInterface fluid metrics, graft nonadherence.ResultsiOCT measurements of interface fluid after final surgical manipulations and immediately before leaving the operating room identified that total fluid volume (P = .002), largest fluid volume pocket (P = .002), max fluid area (P = .006), mean fluid thickness (P = .03), and max fluid thickness (P = .01) significantly correlated with graft nonadherence rates within the first postoperative week. After placement and optimization of intraoperative lenticle adherence, iOCT revealed a significant difference between the area, volume, and thickness of maximum fluid pockets between the 2 surgical techniques, but both techniques resulted in significant reduction of interface fluid during the procedure.ConclusionsLarger residual interface fluid volume, area, and thickness at the end of surgery detected with iOCT are associated with early graft nonadherence and can be quantified with an automated algorithm. iOCT imaging can successfully capture technique-dependent differences in fluid dynamics during DSAEK.

Dataset Information

Outcomes of Intraoperative OCT-Assisted Epiretinal Membrane Surgery from the PIONEER Study.

Publications

Outcomes of Intraoperative OCT-Assisted Epiretinal Membrane Surgery from the PIONEER Study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets