黄斑円孔における術前OCTと術中観察における網膜上増殖検出の不一致
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.
