DISCOVER 研究中的术中 OCT 辅助视网膜脱离修复：影响和结果。
Intraoperative OCT-Assisted Retinal Detachment Repair in the DISCOVER Study: Impact and Outcomes.
机构信息
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
出版信息
Ophthalmol Retina. 2020 Apr;4(4):378-383. doi: 10.1016/j.oret.2019.11.002. Epub 2019 Nov 9.
PURPOSE
The purpose of this study is to evaluate intraoperative OCT (iOCT) utility and outcomes during retinal detachment (RD) repair.
DESIGN
The Determination of Feasibility of Intraoperative Spectral-Domain Microscope Combined/Integrated OCT Visualization during En Face Retinal and Ophthalmic Surgery (DISCOVER) intraoperative OCT study is a prospective Institutional Review Board-approved study.
PARTICIPANTS
Participants in the DISCOVER study undergoing surgical repair for RD.
METHODS
This was a post hoc analysis of eyes in the DISCOVER study undergoing surgical repair for RDs. Inclusion criteria included iOCT after perfluorocarbon liquid placement and at least 6 months follow-up. Exclusion criteria included severe retinal pathology unrelated to RD. Surgeons completed standardized questionnaires after each case evaluating the iOCT instrument's utility. Functional and surgical outcome data were collected at the latest available time point between 6 and 12 months. Outcomes were evaluated in 2 groups: uncomplicated primary and complex cases.
MAIN OUTCOME MEASURES
Intraoperative OCT utility, single-surgery success, and visual acuity outcomes.
RESULTS
A total of 103 eyes were included in this study: 51 uncomplicated primary and 52 complex cases. Intraoperative OCT provided valuable information in 36% of cases. In 12% of cases, iOCT data directly altered surgical decision making. There was a significantly higher rate of valuable iOCT feedback in complex cases compared with primary cases (50% vs. 22%, P < 0.01). Among primary cases, 48 (94%) had successful single surgery repair with a mean postoperative visual acuity of 20/47 compared with the complex group's 75% single surgery success (n=39) and mean postoperative visual acuity of 20/92.
CONCLUSIONS
This study affirms the potential impact of iOCT in assisting select cases of RD repair, particularly with complex pathology. The single surgery success rate was good with more than 80% of cases successfully repaired with 1 surgery.
目的
本研究旨在评估术中光学相干断层扫描（iOCT）在视网膜脱离（RD）修复中的应用效果和结果。
设计
《在视网膜和眼科手术中确定术中光谱域显微镜联合/集成 OCT 可视化可行性（DISCOVER）研究中的术中 OCT》是一项前瞻性机构审查委员会批准的研究。
参与者
接受 RD 手术修复的 DISCOVER 研究参与者。
方法
这是 DISCOVER 研究中接受 RD 手术修复的眼睛的事后分析。纳入标准包括在全氟碳液体放置后进行 iOCT 检查，并进行至少 6 个月的随访。排除标准包括与 RD 无关的严重视网膜病变。每位患者手术后，外科医生都会完成一份标准化问卷，评估 iOCT 仪器的实用性。在 6 至 12 个月的最新随访时间点收集功能和手术结果数据。结果评估分为两组：无并发症的原发性和复杂病例。
主要观察指标
术中 OCT 的实用性、单次手术成功率和视力结果。
结果
本研究共纳入 103 只眼：51 只无并发症的原发性和 52 只复杂病例。术中 OCT 提供了有价值的信息，占 36%。在 12%的情况下，iOCT 数据直接改变了手术决策。与原发性病例相比，复杂病例中 iOCT 反馈有价值的比例明显更高（50%对 22%，P <0.01）。原发性病例中，48 只（94%）成功接受单次手术修复，平均术后视力为 20/47，而复杂组 75%（39 只）成功接受单次手术修复，平均术后视力为 20/92。
结论
本研究证实了 iOCT 在协助选择的 RD 修复病例中的潜在影响，特别是在复杂病变的情况下。单次手术成功率较高，超过 80%的病例经一次手术成功修复。
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