Heads-up Digitally Assisted Surgical Viewing with Intraoperative Optical Coherence Tomography for Myopic Schisis Repair.

PURPOSE: To describe the surgical approach with a screen-based heads-up, three-dimensional (3-D) digital viewing with intraoperative optical coherence tomography (I-OCT) for the successful repair of a myopic macular schisis (MMS) case. CASE REPORT: A 62-year-old woman with vision loss in the left eye was scheduled for pars plana vitrectomy (PPV) and MMS repair. Surgery was performed using the NGENUITYⓇ system for surgical viewing, and foveal-sparing internal limiting membrane (fs-ILM) peeling was performed without gas tamponade, after confirming the absence of iatrogenic macular hole with I-OCT. There were no intraoperative or postoperative complications. Visual acuity improved to 20/40 and the subfoveal macular thickness improved from 706 µm (preoperative) to 221 µm after seven months of follow-up. CONCLUSION: Heads-up digitally assisted viewing technology with I-OCT may be useful or preferred for patients requiring vitreoretinal surgery in the setting of MMS.

Clinical Study on the Initial Experiences of French Vitreoretinal Surgeons with Heads-up Surgery.

Purpose: To evaluate the initial experience of four experienced vitreoretinal surgeons, in France, with a three-dimensional (3-D) system, and to explore the potential advantages and disadvantages of this technology. We also report anatomical surgical outcomes of full-thickness idiopathic macular holes (MH) and primary rhegmatogenous retinal detachment (RRD), by using traditional microscopy and heads-up method. Methods: Four French retinal surgeons performed several types of ophthalmic surgeries with this new technology. To compare the 3-D system with ocular viewing, ergonomics, educational value, image sharpness, depth perception, field of view, technical feasibility, advantages and disadvantages, and expectations for the future, were assessed using a questionnaire. We also compared the same questionnaire with the answers of six Brazilian experienced vitreoretinal surgeons. For treating MHs, the surgeons performed 88 surgeries (44 with microscopy and 44 with 3-D). They performed 100 PPV for treating primary RRD (50 with ocular viewing and 50 with 3-D). The visualization method for each patient, as well as the assignment of each surgeon for a specific patient, were all randomly selected. Results: On the questionnaire, 3-D was preferred to traditional microscopy, except for technical feasibility; the type of surgery benefitting most from the 3-D was macula surgery and the least was anterior segment surgery; the most used by all is the black and white filter in patients with atrophic RPE during ILM peeling. Eighty-one (92.1%) MHs was successfully closed with one surgery and out of the 100 eyes with a primary RRD, the anatomical success after 3 months of follow-up was 91%, with no statistical significance between 3-D and ocular viewing. Conclusions: The surgeons in this study preferred 3-D to ocular viewing. Vitrectomy surgery to treat MHs and RRDs can be performed using the 3-D with the same efficiency as microscopy. Digital integration of 3-D and iOCT can be useful in some cases. With continuous refinement to improve the ability to visualize inside of the eye, this promising technology may enhance what we do as surgeons.

Choriocapillaris Hypoperfusion Artifact in OCT Angiography.

BACKGROUND AND OBJECTIVE: To illustrate how optical coherence tomography (OCT) angiography (OCTA) can be misinterpreted if not evaluated along with structural en face OCT to analyze the signal intensity. PATIENTS AND METHODS: Patients with different macular diseases associated with suspicious flow impairment in the choriocapillaris were recruited to be imaged on the RTVue XR Avanti device (Optovue, Fremont, CA) with the Angio Retina mode. En face OCT angiograms, structural en face OCT, and corresponding OCT B-scans with flow signal overlaid were compared to evaluate the correspondence of signal strength to areas of flow reduction in the choriocapillaris. RESULTS: Six eyes from six patients were enrolled. Macular lesions evaluated in this study included acute central serous chorioretinopathy, paracentral acute middle maculopathy, age-related macular degeneration, adult-onset foveomacular vitelliform dystrophy, and branch retinal vein occlusion. In all cases, areas of suspicious flow decrement in the choriocapillaris corresponded to hyporeflective areas in the intensity en face OCT. Thus, a precise confirmation of choriocapillaris flow impairment was not possible. CONCLUSION: It is essential to be aware of the importance of analyzing the structural image alongside with the flow image to interpret flow impairment. This is more important in subretinal pigment epithelial structures such as choriocapillaris and choroid. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:603-610.].

Exfoliative Cytology in the Diagnosis of Ocular Surface Squamous Neoplasms.

PURPOSE: Surface tumors of the eye comprise an ample spectrum of diseases with various clinical manifestations. Diagnosis has been traditionally achieved through core biopsies, but cytology is an innovative, fast, and minimally invasive method. The objective of this study was to investigate the use of exfoliative cytology as an alternative method for the detection of ocular surface squamous neoplasm (OSSN). METHODS: Exfoliative cytology of the lesions was performed by collecting smears using plastic brushes followed by smearing the cells onto slides and subsequently fixing them in 90% alcohol. Incisional biopsies were performed at the exact same location and sent for processing in 10% formaldehyde. Both the surgical pathologist and cytopathologist were masked to the clinical characteristics and to the corresponding cytological or histological result. RESULTS: Twenty-two patients were enrolled in the study (12 men and 10 women, median age 52.5 years). Final histological diagnoses comprised 7 cases of pterygium, 7 squamous-cell carcinomas, 4 squamous papillomas, and 4 chronic inflammatory processes. Cytohistological agreement was achieved in 19 (86.4%) of the samples. Cytology showed a sensitivity, specificity, positive predictive value, and negative predictive value of 85.7%, 86.7%, 75%, and 92.9%, respectively, in detecting OSSN. CONCLUSIONS: Exfoliative cytology of the conjunctival lesions is a simple procedure, with high agreement to the histological follow-up. Its broad use could augment the early diagnosis of OSSN, with improvement in patient prognosis.