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Effect of Iatrogenic Traction during Macular Peeling Surgery on Postoperative Microperimetry
Christoph Leisser1, Stefan Palkovits1, Julius Hienert1
1VIROS - Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria.
Introduction:
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.
Methods:
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.
Results:
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.
Conclusion:
New deep microscotomata developed only in a minority of patients with transient retinal thickening owing to tractional forces during peeling.
Insights
Intraoperative optical coherence tomography (iOCT) revealed transient retinal thickening during epiretinal membrane (ERM) peeling in most patients. This thickening rarely led to new visual field defects (microscotomata) after surgery.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Medical Imaging
Background:
- Vitrectomy with epiretinal membrane (ERM) and internal limiting membrane peeling can improve vision.
- Microscope-integrated intraoperative optical coherence tomography (iOCT) allows real-time imaging during peeling.
- Transient retinal thickening due to tractional forces is observed during membrane peeling.
Purpose of the Study:
- To quantify transient retinal thickening during ERM peeling using iOCT.
- To analyze the impact of this thickening on postoperative retinal function.
Main Methods:
- Prospective, monocenter study of patients undergoing pars plana vitrectomy for idiopathic ERM.
- Continuous iOCT and video documentation during membrane peeling.
- Macular-OCT and microperimetry performed preoperatively and 3 months postoperatively.
Main Results:
- iOCT analysis was possible in 22 of 25 patients.
- Transient retinal thickening was observed in 64% of patients, with a median increase to 143% of normal thickness.
- New deep microscotomata developed in 24% of patients; 2 of these also had transient retinal thickening.
Conclusions:
- Transient retinal thickening during ERM peeling is common.
- New deep microscotomata occur in a minority of patients experiencing this thickening.
