The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland, Ohio, USA.
Cole Eye Institute Retina Service, Cleveland Clinic, Cleveland, Ohio, USA.
Br J Ophthalmol. 2021 Mar;105(3):403-409. doi: 10.1136/bjophthalmol-2020-316045. Epub 2020 May 6.
BACKGROUND/AIMS: This study aimed to characterise the clinical outcomes and utility of intraoperative optical coherence tomography (iOCT)-assisted macular hole (MH) repair.
This was a post hoc analysis of eyes in the etermination of feasibility of ntraoperative pectral domain microscope ombined/integrated CT isualization during n face etinal and ophthalmic surgery (DISCOVER) study undergoing surgical MH repair with use of iOCT. Functional and surgical outcome data were collected through 12 months postoperatively. MH closure rate, postoperative visual acuity (VA), percentage of cases in which iOCT provided valuable feedback and altered surgical decision making were measured.
Eighty-four eyes were included in this study. The mean preoperative VA measured 20/114. The mean postoperative VA improved to 20/68 (p<0.001) at month 1, 20/48 (p<0.001) at month 3 and 20/45 (p<0.001) at month 12 or later. In 43 cases (51%), surgeons reported that iOCT provided valuable information (eg, confirming release of vitreomacular traction and identification of occult residual membranes). In 10 cases (12%), iOCT data specifically altered surgical decision making. Postoperative day 1 transtamponade OCT confirmed tissue apposition and apparent hole closure in 74% of eyes (21/26). All five open holes on postoperative day 1 closed following positioning. Single-surgery MH closure was achieved in 97.6% of cases. One persistent MH was successfully closed with a subsequent surgical repair for a final overall closure rate of 98.8%. Due to chronicity and MH size, additional repair was not recommended for the single remaining persistent MH.
This study suggests that iOCT may have important utility in MH surgery, including impacting surgical decision making. iOCT-assisted MH surgery resulted in significant improvement in VA and high single-surgery success rate.
背景/目的：本研究旨在描述术中光学相干断层扫描（iOCT）辅助黄斑裂孔（MH）修复的临床结果和实用性。
这是对在眼科手术中应用光谱域显微镜联合/整合光学相干断层扫描成像可行性的评估（DISCOVER）研究中接受手术 MH 修复的患者的一项术后分析，这些患者术中应用了 iOCT。术后 12 个月收集功能和手术结果数据。测量 MH 闭合率、术后视力（VA）、iOCT 提供有价值反馈并改变手术决策的病例百分比。
本研究纳入 84 只眼。术前平均 VA 为 20/114。术后 1 个月 VA 提高至 20/68（p<0.001），术后 3 个月提高至 20/48（p<0.001），术后 12 个月或之后提高至 20/45（p<0.001）。43 例（51%）的外科医生报告说，iOCT 提供了有价值的信息（例如，确认玻璃体黄斑牵引的释放和隐匿性残余膜的识别）。在 10 例（12%）中，iOCT 数据特别改变了手术决策。术后第 1 天经 transtamponade OCT 证实 74%（21/26）的眼组织贴合，孔明显闭合。所有 5 例术后第 1 天的开放孔在定位后均闭合。97.6%（26/27）的病例单手术 MH 闭合。1 例持续性 MH 经后续手术修复成功，最终总体闭合率为 98.8%。由于慢性和 MH 大小，不建议对唯一剩余的持续性 MH 进行额外修复。
本研究表明，iOCT 在 MH 手术中可能具有重要的实用性，包括影响手术决策。iOCT 辅助 MH 手术可显著提高 VA，单手术成功率高。
