Pichi Francesco, Alkabes Micol, Nucci Paolo, Ciardella Antonio P
San Giuseppe Hospital, University Eye Clinic, Milan, Italy. ilmiticopicchio@ gmail.com
Ophthalmic Surg Lasers Imaging. 2012 Nov-Dec;43(6 Suppl):S54-60. doi: 10.3928/15428877-20121001-08.
Intraoperative use of spectral-domain optical coherence tomography (SD-OCT) using an OCT-mounted surgical microscope could provide additional information to predict visual outcomes of macular surgery and identify intraoperative changes in the macular anatomy that affect visual recovery.
This interventional retrospective case study included 5 eyes of 5 consecutive patients with various macular pathologies. All patients underwent the standard surgery for idiopathic macular holes and epiretinal membranes (ERMs) using the same 25-gauge three-port pars plana technique. If present, the ERM was removed. The dye procedure was then repeated to stain and remove the internal limiting membrane (ILM). OCT images were obtained with the retinal map or cross-section program preincision, post-hyaloid elevation (if applicable), post-residual ERM peel (if applicable), and post-ILM peel.
In 3 of 5 patients, the intraoperative scan revealed an increased area of subretinal hyporeflectivity corresponding with a clinically visible "cuff" of retinal detachment. In 2 patients, the SD-OCT scan taken immediately after ERM removal helped find a cleavage plane for the subsequent ILM peeling, which could be further confirmed by a scan taken immediately after it. In 2 cases, the scans identified intraoperative complications that otherwise would not have been noted and allowed the surgeon to modify the next procedures during surgery.
Use of this technology in an operative setting can provide greater insight into the changes in retinal anatomy created during macular surgery.
术中使用安装了光学相干断层扫描（OCT）的手术显微镜进行光谱域光学相干断层扫描（SD - OCT），可为预测黄斑手术的视觉效果提供额外信息，并识别影响视力恢复的黄斑解剖结构的术中变化。
本介入性回顾性病例研究纳入了5例连续患有各种黄斑病变患者的5只眼睛。所有患者均采用相同的25G三通道平坦部玻璃体切割术，进行特发性黄斑裂孔和视网膜前膜（ERM）的标准手术。如有ERM，则将其切除。然后重复染色程序以染色并去除内界膜（ILM）。在切开前、玻璃体后脱离（如适用）后、残留ERM剥除后（如适用）以及ILM剥除后，使用视网膜地图或横截面程序获取OCT图像。
5例患者中有3例，术中扫描显示视网膜下低反射区面积增加，与临床上可见的视网膜脱离“袖带”相对应。在2例患者中，ERM切除后立即进行的SD - OCT扫描有助于找到后续ILM剥除的分离平面，这可在剥除后立即进行的扫描中得到进一步证实。在2例病例中，扫描识别出了术中并发症，否则这些并发症可能不会被注意到，并使外科医生能够在手术期间修改后续手术步骤。
在手术环境中使用该技术可以更深入地了解黄斑手术过程中视网膜解剖结构的变化。
