Feasibility and utility of intraoperative optical coherence tomography during vitreoretinal surgery:A 4-year report in Chinese population

The objective is to introduce the application of intraoperative optical coherence tomography(iOCT)in pars plana vitrectomy(PPV)for various vitreoretinal diseases,and to report the 4-year assessment of feasibility and utility in Chinese population.We reported a retrospective case series of patients who underwent PPV and iOCT scan at Eye Hospital of Wenzhou Medical University from January 2016 to January 2020.Clinical characteristics were documented before operation,and we intraoperatively recorded the time and results of iOCT scanning,specific surgical maneuvers performed,the consistency with the planned strategies before surgery,the type of OCT images obtained,and adverse events(AEs).The surgeon feedback was collected to evaluate the utility of iOCT during surgery.In total 339 eyes successfully completed iOCT scan,with an average scanning time of 3.54±2.3 min,including 59 cases of idiopathic macular hole(iMH),134 cases of idiopathic epiretinal membrane(iERM),33 cases of lamellar macular hole(LMH),40 cases of high myopic maculopathy,13 cases of vitreous macular traction(VMT),60 cases of dense vitreous hemorrhage(VH).The iOCT findings were not consistent with exami-nation under the operating microscope in 49 cases(14.5%),including 29 cases(8.6%)which changed the operation strategies during surgery.The Hole-door phenomenon arose in 20 cases(33.9%)of iMH and 3 cases(25%)of high myopic MH after ILMs peeling.Moreover,the residue ERM was observed in nine cases(6.7%)of iERM and two cases(14.3%)in high myopic ERM after ILMs peeling.Some new surgical methods could also be confirmed using iOCT.The ap-plication of iOCT has a significant clinical functionality in vitreoretinal surgery,providing the surgeon with a new surgical understanding,guiding the selection of a more reasonable operative procedure during surgery,predicting postoperative recovery and improving postoperative outcomes.

玻璃体切割联合内界膜剥除和空气填充治疗特发性黄斑裂孔

目的:观察玻璃体切割手术联合内界膜剥除和空气填充治疗特发性全层黄斑裂孔(IMH)的疗效。方法:回顾性系列病例研究。收集2017年1月至2018年1月在温州医科大学附属眼视光医院杭州院区确诊并行玻璃体切割术治疗的连续IMH患者32例(32眼),年龄47~78(60.7±12.2)岁,其中男9例,女23例。术中均采用消毒空气进行眼内填充。根据术后早期首次光学相干断层扫描(OCT)提示裂孔是否闭合分为闭合组和未闭合组,对2组患者术前、术后的最佳矫正视力(BCVA)、裂孔直径等采用秩和检验及独立样本t检验进行比较;2组患者裂孔闭合率及外界膜和光感受器连续性比较采用卡方检验。结果:术后末次随访时所有患者LogMARBCVA为0.40(0.30,0.73),较术前[0.80(0.70,1.00)]明显提高(Z=-3.439,P<0.001)。术后早期OCT扫描显示24例黄斑裂孔闭合,8例黄斑裂孔未闭合,予再次玻璃体腔空气填充治疗,术后1个月及术后末次随访所有患者黄斑裂孔均闭合。术后1个月OCT扫描外界膜(ELM)连续的患者有16例,无一例椭圆体层(EZ)连续;末次随访时18例患者ELM连续,6例EZ连续。未闭合组术前黄斑裂孔直径为(532±104)μm,明显大于闭合组黄斑裂孔直径[(352±180)μm](t=-2.656,P=0.013)。闭合组术后1个月ELM均存在连续性,末次随访ELM和EZ连续性均高于未闭合组,2组差异具有显著的统计学意义(χ^2=4.23,P=0.040;χ^2=3.89,P=0.048)。结论:玻璃体切割联合ILM剥除和空气填充治疗IMH具有较好的疗效,对于大于400μm的裂孔部分患者需要再次玻璃体腔空气填充治疗。

术中OCT在致密玻璃体积血玻璃体切割手术中的应用

目的：评估术中光学相干断层扫描（iOCT）在致密玻璃体积血手术中的临床应用价值。方法：回顾性系列病例研究。收集2015年6月至2016年9月在温州医科大学附属眼视光医院采取玻璃体切割手术治疗的致密玻璃体积血患者共24例（24眼），其中男14例，女10例，平均年龄（62．3±16．6）岁。所有患者术中清除致密出血后行iOCT检查，了解黄斑情况。记录iOCT检查时间及结果，对比iOCT结果与术者显微镜下观察判断是否一致，观察iOCT结果是否对手术治疗策略产生影响，以及与检查相关的并发症发生情况。结果：纳入的24例病例中，糖尿病视网膜病变15例，视网膜静脉阻塞4例，视网膜裂孔1例，息肉状脉络膜血管病变2例，大动脉瘤1例，不明原因新生血管1例。iOCT结果提示10例患者术中黄斑区结构正常，14例结构异常：其中黄斑水肿8例，黄斑前膜2例，黄斑前膜伴水肿1例，黄斑萎缩2例，黄斑板层裂孔1例。iOCT检查结果与手术者手术显微镜观察结果不一致为6例；因iOCT结果而改变手术策略的有4例。未见与检查相关的眼内炎等并发症发生。结论：iOCT在致密玻璃体积血患者玻璃体切割术中的应用可给手术者提供显微镜下无法察觉的黄斑区异常改变，指导术者选择更为合理的手术方式。