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A discrepancy in epiretinal proliferation detection between preoperative OCT and intraoperative observation in
Masaki Fukushima1,2,3, Atsushi Hayashi1, Shunji Kusaka2
1Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Sugitani, Toyama, 2630, 930-0194, Japan.
Purpose:
Epiretinal proliferation (EP) is associated with poor visual and anatomical outcomes in eyes with macular holes (MHs). A preoperative cross-sectional OCT can detect EP; however, We observed that some cases with intraoperatively visible EP showed no evidence of EP on preoperative OCT. This study assessed the discrepancy between EP observed by OCT and during surgery.
Methods:
We defined OCT-EP as epiretinal materials with homogeneous medium reflectivity observed in cross-sectional OCT. We defined surgical-EP as yellowish tissues contiguous to the hole during the membrane peeling. We detected the surgical-EP by also assessing the internal limiting membrane staining pattern using Brilliant Blue G (BBG) and preretinal abnormal tissue (PAT) using en face OCT.
Results:
We included 110 eyes. Intraoperative observations revealed surgical-EP in 30 (27%) eyes, while preoperative OCT revealed EP in 26 (24%) eyes. Setting the surgical-EP as the ground truth gave a sensitivity of preoperative OCT for the detection of EP of 87% and specificity of 100%. In 4 of the 30 eyes (13%), EP was not detected on preoperative OCT and all of these eyes exhibited peri-MH nonstaining areas. Peri-MH nonstaining area and peri-MH PAT were larger in eyes with surgical-EP than in eyes without surgical-EP (P = 0.0001 and P = 0.0029).The area under the receiver operating characteristic curve was 84.3% for the peri-MH nonstaining area for detection of surgical-EP and 94.8% for peri-MH PAT.
Conclusions:
Preoperative cross-sectional OCT may overlook EP. The BBG staining patterns and en face OCT provide additional clues for detecting EP. Key messages What is known • Epiretinal proliferation (EP) is a known biomarker correlated with poor visual and anatomical outcomes in eyes with macular hole. • Cross-sectional OCT is the standard modality for the detection of preoperative EP but may fail to identify subtle cases. What is new • There is a 13% discrepancy between preoperative OCT and intraoperative observation to detect EP. • Using only preoperative cross-sectional OCT may overlook the presence of EP. • Brilliant blue G staining pattern and en face OCT may be useful to identify undetectable EP by OCT.
