Imaging the Intraoperative Macular Morphology Changes using a Handheld Spectral Domain Optical Coherence Tomography.

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.