Intraoperative optical coherence tomography in macula involving rhegmatogenous retinal detachment repair with pars plana vitrectomy and perfluoron

• Published in: Eye (London) Vol. 30; no. 1; pp. 23 - 30
• Main Authors: Toygar, O, Riemann, C D
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-01-2016; Nature Publishing Group
• Subjects: 692/308/409; 692/699/3161/3175; Aged; Aged, 80 and over; Clinical Study; Endotamponade; Female; Fluorocarbons - administration & dosage; Humans; Intraoperative Period; Laboratory Medicine; Macula Lutea - pathology; Male; Medicine; Medicine & Public Health; Middle Aged; Ophthalmology; Pharmaceutical Sciences/Technology; Retinal Detachment - diagnosis; Retinal Detachment - physiopathology; Retinal Detachment - surgery; Surgery; Surgery, Computer-Assisted; Surgical Oncology; Tomography, Optical Coherence; Visual Acuity - physiology; Vitrectomy
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/eye.2015.230

Purpose
To investigate microanatomical relationships during surgical repair of macula involving retinal detachment with pars plana vitrectomy (PPV) and perfluoron (PFO) with a microscope-integrated intraoperative optical coherence tomography (iOCT) device.
Patients and methods
This consecutive case series included nine eyes of nine patients with macula involving retinal detachment operated by a single surgeon at the Cincinnati Eye Institute. All patients underwent PPV, PFO injection, endolaser, and air–fluid exchange. The macula was imaged with iOCT before PFO injection, after PFO injection, and after air–fluid exchange in all eyes.
Results
iOCT imaging was ergonomically easy to obtain in all eyes. iOCT clearly demonstrated submacular fluid (SMF) at the beginning of the surgery, macular flattening under PFO in all eyes, small residual SMF under PFO in six of nine eyes, and increased occult SMF following air–fluid exchange in all eyes.
Conclusion
Microscope-integrated iOCT is a versatile and powerful imaging modality that holds a great deal of promise in the future. Its confirmation of persistent occult SMF in this small series of macular involving retinal detachment repair with PFO, may inform surgical decision making, and demonstrates a pathophysiological rationale for initial face-down positioning after retinal detachment repair.