VISUALIZATION FROM INTRAOPERATIVE SWEPT-SOURCE MICROSCOPE-INTEGRATED OPTICAL COHERENCE TOMOGRAPHY IN VITRECTOMY FOR COMPLICATIONS OF PROLIFERATIVE DIABETIC RETINOPATHY

• Published in: Retina (Philadelphia, Pa.) Vol. 38 Suppl 1; p. S110
• Main Authors: Gabr, Hesham, Chen, Xi, Zevallos-Carrasco, Oscar M, Viehland, Christian, Dandrige, Alexandria, Sarin, Neeru, Mahmoud, Tamer H, Vajzovic, Lejla, Izatt, Joseph A, Toth, Cynthia A
• Format: Journal Article
• Language: English
• Published: United States 01.09.2018
• Subjects: Adult; Aged; Diabetic Retinopathy - complications; Diabetic Retinopathy - diagnosis; Diabetic Retinopathy - physiopathology; Female; Humans; Intraoperative Period; Male; Microscopy - methods; Middle Aged; Prospective Studies; Retinal Detachment - diagnosis; Retinal Detachment - etiology; Retinal Detachment - surgery; Tomography, Optical Coherence - methods; Treatment Outcome; Visual Acuity; Vitrectomy - methods; Vitreous Hemorrhage - diagnosis; Vitreous Hemorrhage - etiology; Vitreous Hemorrhage - surgery
• ISSN: 1539-2864
• DOI: 10.1097/IAE.0000000000002021

To evaluate the use of live volumetric (4D) intraoperative swept-source microscope-integrated optical coherence tomography in vitrectomy for proliferative diabetic retinopathy complications. In this prospective study, we analyzed a subgroup of patients with proliferative diabetic retinopathy complications who required vitrectomy and who were imaged by the research swept-source microscope-integrated optical coherence tomography system. In near real time, images were displayed in stereo heads-up display facilitating intraoperative surgeon feedback. Postoperative review included scoring image quality, identifying different diabetic retinopathy-associated pathologies and reviewing the intraoperatively documented surgeon feedback. Twenty eyes were included. Indications for vitrectomy were tractional retinal detachment (16 eyes), combined tractional-rhegmatogenous retinal detachment (2 eyes), and vitreous hemorrhage (2 eyes). Useful, good-quality 2D (B-scans) and 4D images were obtained in 16/20 eyes (80%). In these eyes, multiple diabetic retinopathy complications could be imaged. Swept-source microscope-integrated optical coherence tomography provided surgical guidance, e.g., in identifying dissection planes under fibrovascular membranes, and in determining residual membranes and traction that would benefit from additional peeling. In 4/20 eyes (20%), acceptable images were captured, but they were not useful due to high tractional retinal detachment elevation which was challenging for imaging. Swept-source microscope-integrated optical coherence tomography can provide important guidance during surgery for proliferative diabetic retinopathy complications through intraoperative identification of different complications and facilitation of intraoperative decision making.