VIROS - Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria.
VIROS - Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria,
Ophthalmic Res. 2021;64(2):273-279. doi: 10.1159/000507633. Epub 2020 Apr 1.
Vitrectomy with peeling of epiretinal membrane (ERM) and internal limiting membrane offers the chance for improvement of metamorphopsia and visual acuity. Microscope integrated intraoperative optical coherence tomography (iOCT) enables real-time imaging of retinal alterations during peeling, such as intraoperative transient retinal thickening owing to tractional forces during peeling. The aim of our study was to measure the amounts of transient retinal thickening due to tractional forces during membrane peeling, as documented with iOCT, and to analyze possible effects on postoperative retinal function.
This prospective, monocenter study included patients scheduled for pars plana vitrectomy with membrane peeling due to an idiopathic ERM. During peeling, an iOCT device (ReScan700, Carl Zeiss Meditec AG) with continuous OCT-assistance during the peeling procedure, and video documentation of the peeling procedure, was used for the assessment of intraoperative transient retinal thickening owing to tractional forces during peeling. Directly before and 3 months after surgery, macular-OCT scans and microperimetry were performed.
Twenty-five eyes of 25 patients were included in the study. Microperimetry could be performed in all patients, while iOCT documentation could be analyzed in 22 patients. Transient retinal thickening owing to tractional forces during peeling could be observed in 14 patients (64%), with a median thickening to 143% of the normal (preoperative) retinal thickness at that location (IQR 132-163). Six patients (24%) developed new deep microscotomata as seen in microperimetry 3 months after surgery, among them were 2 patients who also had transient retinal thickening during peeling.
New deep microscotomata developed only in a minority of patients with transient retinal thickening owing to tractional forces during peeling.
玻璃体切除联合视网膜内界膜和视网膜前膜剥除术为改善变形性和视力提供了机会。显微镜集成术中光学相干断层扫描（iOCT）可实时成像视网膜在剥除过程中的改变，例如由于剥除过程中的牵引力导致术中瞬时视网膜增厚。我们的研究目的是测量 iOCT 记录的由于膜剥除过程中的牵引力导致的瞬时视网膜增厚量，并分析其对术后视网膜功能的可能影响。
这项前瞻性、单中心研究纳入了因特发性视网膜前膜而接受标准经睫状体平坦部玻璃体切除术联合膜剥除术的患者。在剥除过程中，使用 iOCT 设备（Carl Zeiss Meditec AG 的 Rescan700），在剥除过程中连续进行 OCT 辅助，并对剥除过程中的视网膜进行视频记录，以评估由于牵引力导致的术中瞬时视网膜增厚。手术前和手术后 3 个月直接进行黄斑 OCT 扫描和微视野检查。
本研究纳入了 25 例 25 只眼的患者。所有患者均能进行微视野检查，22 例患者可进行 iOCT 记录分析。在 14 例患者（64%）中观察到由于牵引力导致的瞬时视网膜增厚，该部位的视网膜厚度增厚至正常（术前）视网膜厚度的 143%（中位数，IQR 132-163）。6 例患者（24%）在术后 3 个月的微视野检查中出现新的深层微盲点，其中 2 例患者在剥除过程中也出现了瞬时视网膜增厚。
只有少数因牵引力导致瞬时视网膜增厚的患者出现新的深层微盲点。
