Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft · 2019
[Intraoperative optical coherence tomography in explorative vitrectomy in patients with vitreous haemorrhage-a case series].
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Heinrich D, Bohnacker S, Nasseri M A, Feucht N, Lohmann C P, Maier M
Аннотация
BACKGROUND: High-resolution spectral domain optical coherence tomography (SD-OCT) is a gold standard technique for diagnosis, management and monitoring of patients with vitreoretinal diseases. Preoperative diagnostics for evaluation of intraocular and retinal status in patients with vitreous haemorrhage are limited, thus final therapeutic decisions can only be made during explorative vitrectomy. We evaluated the use of intraoperative SD-OCT (iSD-OCT) as a real-time additional diagnostic tool during explorative vitrectomy in patients with vitreous haemorrhage.
METHODS: We report on 9 patients (11 eyes) with vitreous haemorrhage. Preoperative ultrasound was performed to evaluate intraocular status. Subsequently, an explorative 23G pars plana vitrectomy was performed under visualisation with the OPMI Lumera 700 surgical microscope (Carl Zeiss Meditec, Jena, Germany) equipped with a fully integrated iSD-OCT device (Rescan 700, Carl Zeiss Meditec, Jena, Germany) as a real-time diagnostic tool.
RESULTS: In all patients, intraoperative iSD-OCT allowed real-time evaluation of the preretinal, intraretinal and subretinal structures in addition to the intraoperative en face image. The further surgical strategy, i. e. necessity for peeling of epiretinal membranes (ERM) or of the inner limiting membrane (ILM), application of intravitreal medication and selection of the appropriate tamponade, was based on and optimised according to the iSD-OCT images.
CONCLUSION: Intraoperative iSD-OCT is highly useful as an additional intraoperative diagnostic tool in patients with vitreous haemorrhage. In addition to the en face microscope image, it facilitates intraoperative real-time diagnosis and aids therapeutic decision-making during surgery.
METHODS: We report on 9 patients (11 eyes) with vitreous haemorrhage. Preoperative ultrasound was performed to evaluate intraocular status. Subsequently, an explorative 23G pars plana vitrectomy was performed under visualisation with the OPMI Lumera 700 surgical microscope (Carl Zeiss Meditec, Jena, Germany) equipped with a fully integrated iSD-OCT device (Rescan 700, Carl Zeiss Meditec, Jena, Germany) as a real-time diagnostic tool.
RESULTS: In all patients, intraoperative iSD-OCT allowed real-time evaluation of the preretinal, intraretinal and subretinal structures in addition to the intraoperative en face image. The further surgical strategy, i. e. necessity for peeling of epiretinal membranes (ERM) or of the inner limiting membrane (ILM), application of intravitreal medication and selection of the appropriate tamponade, was based on and optimised according to the iSD-OCT images.
CONCLUSION: Intraoperative iSD-OCT is highly useful as an additional intraoperative diagnostic tool in patients with vitreous haemorrhage. In addition to the en face microscope image, it facilitates intraoperative real-time diagnosis and aids therapeutic decision-making during surgery.