Application of intraoperative OCT in fundus surgery / 中华实验眼科杂志

Optical coherence tomography (OCT) is an optical diagnostic technique that provides non-contact, non-invasive tomographic imaging of microscopic structures of living ocular tissues.However, it requires the patient to be seated during the examination, which limits its use in infants and recumbent patients.Intraoperative OCT (iOCT) can be used in patients in the decubitus position to provide the surgeon with critical real-time information on anatomy and subtle lesions, improving the success and safety of the procedure.At present, the clinically applied iOCT types include handheld OCT, microscope-mounted OCT, microscope-integrated OCT and so on, among which integrated microscope-integrated OCT is the most widely used.iOCT is mainly used in a variety of fundus surgeries, retinal detachment reduction and proliferative diabetic retinopathy resection in retinal disease surgeries, and macular hole repair and anterior macular membrane stripping in macular surgery.During surgery, the use of iOCT can play a role in reducing surgical complications, detecting subclinical lesions, helping the surgeon make the most appropriate surgical decision, and predicting patient prognosis.This article reviewed the classifications of iOCT, as well as its advantages and disadvantages in the application of retinal detachment, diabetic retinopathy, macular epiretinal membrane, macular hole and other diseases to provide a reference for clinical practitioners.

Intraoperative optical coherence tomography and proportional reflux hydrodissection-guided pars plana vitrectomy for complex severe proliferative diabetic retinopathy

The study describes the technique of combining microscope-integrated optical coherence tomography (mi-OCT) and proportional reflux hydrodissection (PRH) during pars plana vitrectomy (PPV) in eyes with complex proliferative diabetic retinopathy (PDR) including tractional retinal detachment (TRD), combined retinal detachment (CRD), and taut posterior hyaloid membrane (TPHM). In this technique, PRH is used to create tissue planes between fibrovascular adhesions in areas identified using mi-OCT for insinuating the vitrector, enabling tissue dissection and release of traction. About 46 patients were operated using this technique. 34 eyes had TRD, 9 eyes had CRD, and 3 eyes were diagnosed with TPHM. A second instrument was used only in nine eyes. None of the eyes required use of intraocular scissors. Iatrogenic breaks occurred in six eyes. All patients had successful reattachment at 3-month follow-up. Thus, combination of mi-OCT and PRH is useful incomplete fibrovascular tissue dissection during PPV for complex PDR cases.