ABSTRACT
@# As a major innovation in macular surgery over the past 30 years,internal limiting membrane peeling has now become standard operation after all-round improvements. However, how to achieve optimal response and avoid poor prognosis by peeling the internal limiting membrane, which is the basement membrane of the Müller cells representing the structural interface between retina and vitreous, still needs to be explored. Prof. Peter Wiedemann, the co-editor-in-chief of our journal, in view of his long-term outstanding contributions to retinal surgery and the important progress his team has made in foveal regeneration, wrote this review with a special invitation. He gladly completed this article in 2wk, which is comprehensive, outlined, insightful, concise and shining with wisdom. It summarizes the history, rationale, techniques, indications, size and adverse outcomes of internal limiting membrane peeling and the surgery for refractory macular hole. It not only affirms current cognition, but raises existing problems, which are worthy reading and reflecting, so it was translated for readers' convenience.
ABSTRACT
Purpose: To study the intraoperative retinal macular morphology during macular surgery using handheld spectral domain optical coherence tomography (SDOCT). Design: Prospective, observational case series. Methods: A handheld SDOCT device was used to characterize the preoperative and intraoperative OCT images in 10 eyes of 10 patients undergoing vitrectomy for macular hole (MH) and epiretinal membrane (ERM). I intraoperative imaging was repeated after removal of the internal limiting membrane or the ERM and the images were analyzed. Results: Intraoperative SDOCT images from patients undergoing surgery (5 for full thickness MH including 2 previously failed surgeries and 5 for ERM were reviewed and quantitatively analyzed. In the 5 eyes undergoing surgery for MH, the minimum diameter of the hole showed a significant decrease (P = 0.031; the mean reduction 15.18%; range 6.14- 34.88%). Basal diameter increased in 2 eyes (mean change 9.96%), reduced in 2 (mean reduction 3.28%) while it remained unchanged in 1 case. The MH height decreased in 2 eyes (mean reduction 5.43%) and increased in 3 (mean change 20.04%). Intraoperative imaging in 5 eyes undergoing surgery for ERM revealed immediate decrease in retinal thickness in 3 eyes (mean change 5.00%), and increase in 2 eyes (mean change 17.76%). Comparison of the preincisional and intraoperative handheld SDOCT images demonstrated distinct changes in retinal macular morphology. Conclusion: The intraoperative use of handheld SDOCT provides a novel method for visualizing and quantifying changes in retinal anatomy during macular surgery. Further study is warranted to determine whether intraoperative macular morphological changes could affect and prognosticate MH closure.