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.

Rotational stability of plate haptic toric intraocular lenses after combined 25-gauge vitrectomy and cataract surgery

AIM:To evaluate the postoperative intraocular lens(IOL)rotational stability and residual refractive astigmatism following combined 25-gauge vitrectomy and cataract surgery with implantation of a plate haptic toric IOL.METHODS:In this retrospective case series,32 eyes of 32 patients underwent a combined 25-gauge vitrectomy and phacoemulsification for vitreoretinal diseases and cataract with regular corneal astigmatism of at least 1 diopter(D).A plate haptic toric IOL(AT Torbi 709M,Carl Zeiss Meditec AG)was implanted in all eyes.The outcome measures were rotational stability and refractive astigmatism up to 6mo postoperatively as well as the best corrected visual acuity(BCVA).RESULTS:Preoperative refractive astigmatism was 2.14±1.17 D,which was significantly reduced to 0.77±0.37 D six to eight weeks postoperatively and remained stable throughout the observation period(0.67±0.44 D at three months and 0.75±0.25 D at six months;for all groups:P<0.0001 compared to baseline).BCVA improved significantly from 0.36±0.33 logMAR preoperatively to 0.10±0.15 logMAR following surgery(P=0.02).Mean IOL axis deviation from the target axis was 3.4°±2.9°after six to eight weeks and significantly decreased over time(2.4°±2.6°six months after surgery;P=0.04).In one patient IOL,re-alignment was performed.CONCLUSION:Corneal astigmatism is significantly reduced following combined 25-gauge vitrectomy and cataract surgery.The plate haptic toric IOL position and axis remain stable during the observation period of six months.