Lytvynchuk Lyubomyr M, Falkner-Radler Christiane I, Krepler Katharina, Glittenberg Carl G, Ahmed Daniel, Petrovski Goran, Lorenz Birgit, Ansari-Shahrezaei Siamak, Binder Susanne
Department of Ophthalmology, Justus Liebig University, University Hospital Giessen and Marburg GmbH, Campus Giessen, Friedrichstrasse 18, 35392, Giessen, Germany.
Karl Landsteiner Institute for Retinal Research and Imaging, Juchgasse 25, 1030, Vienna, Austria.
Graefes Arch Clin Exp Ophthalmol. 2019 Aug;257(8):1649-1659. doi: 10.1007/s00417-019-04364-5. Epub 2019 May 28.
BACKGROUND/OBJECTIVES: To assess the efficacy of dynamic intraoperative spectral-domain optical coherence tomography (iSD-OCT) imaging for inverted internal limiting membrane (ILM) flap technique (IILMFT) in large macular hole (MH) surgery.
SUBJECTS/METHODS: Prospective, non-randomized, observational study was conducted on 8 eyes of 7 patients with large, chronic and recurrent MHs, which were treated by pars plana vitrectomy (PPV) with IILMFT. All patients underwent standard pre- and postoperative examination. The iSD-OCT imaging was performed using microscope integrated systems before, during, and after ILM peeling. The iSD-OCT data were post-processed using graphic software and reviewed for tissue behavior and instruments position.
The real-time iSD-OCT-assisted IILMFT allowed for real-time imaging of the entire surgery with visualization of the MH, vitreoretinal instruments, and all steps of inverted ILM flap formation. In spite of shadowing created by the steel instruments, it was possible to follow and control the distance between the instrument tips and retinal layers. Dynamic imaging of the surgical maneuvers including ILM peeling and mechanical apposition of MH edges revealed the iatrogenic impact on the retina (depression and appearance of hyporeflective zones). iSD-OCT imaging could confirm the proper position of the inverted ILM flap at the very end of the surgery after fluid-air exchange.
iSD-OCT imaging is an effective tool for learning and performing a well-controlled and safe inverted ILM flap technique in patients with large MH. Clinical significance of the structural iSD-OCT findings has to be further studied.
背景/目的：评估术中动态光谱域光学相干断层扫描（iSD-OCT）成像在治疗大黄斑裂孔（MH）手术中应用倒置内界膜（ILM）瓣技术（IILMFT）的疗效。
受试者/方法：对7例患有大的、慢性复发性MH的患者的8只眼睛进行前瞻性、非随机、观察性研究，采用经睫状体平坦部玻璃体切除术（PPV）联合IILMFT治疗。所有患者均接受标准的术前和术后检查。在ILM剥离前、剥离过程中和剥离后，使用显微镜集成系统进行iSD-OCT成像。使用图形软件对iSD-OCT数据进行后处理，并检查组织行为和器械位置。
实时iSD-OCT辅助IILMFT能够对整个手术进行实时成像，可观察到MH、玻璃体视网膜器械以及倒置ILM瓣形成的所有步骤。尽管钢制器械会产生阴影，但仍可追踪并控制器械尖端与视网膜层之间的距离。包括ILM剥离和MH边缘机械对合在内的手术操作的动态成像显示了对视网膜的医源性影响（视网膜凹陷和低反射区出现）。iSD-OCT成像可在气液交换后手术结束时确认倒置ILM瓣的正确位置。
iSD-OCT成像是学习和对大MH患者进行良好控制且安全的倒置ILM瓣技术的有效工具。iSD-OCT结构发现的临床意义有待进一步研究。
