ILM peeling technique influences the degree of a dissociated optic nerve fibre layer appearance after macular hole surgery

Steel, David; Dinah, Christiana; Habib, Maged; White, Kathryn

doi:10.1007/s00417-014-2734-z

Cited by 43 publications

(26 citation statements)

References 25 publications

(36 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In regards to the role of specific surgical instruments architectural alterations, Steel et al 20 compared the forcepsonly group (41 eyes) versus DDMS-only group (16 eyes) and concluded that the DDMS was associated with increased postoperative retinal changes. Importantly, no iOCT data were available in this study.…”

Section: Discussionmentioning

confidence: 99%

Membrane Peeling-Induced Retinal Alterations on Intraoperative OCT in Vitreomacular Interface Disorders From the PIONEER Study

Ehlers

Han

Petkovsek

et al. 2015

Invest. Ophthalmol. Vis. Sci.

View full text Add to dashboard Cite

PURPOSE. To assess retinal architectural alterations that occur following membrane peeling procedures and the impact of peel technique on these alterations utilizing intraoperative optical coherence tomography (iOCT).METHODS. This is a subanalysis of the prospective PIONEER iOCT study of eyes undergoing a membrane peeling for a vitreomacular interface (VMI) disorder. Intraoperative scanning was performed with a microscope-mounted OCT system. Macroarchitectural alterations (e.g., fullthickness retinal elevations) and microarchitectural alterations (e.g., relative layer thickness alterations) were analyzed. Video/iOCT correlation was performed to identify instrumenttissue manipulations resulting in macroarchitectural alterations. RESULTS.One hundred sixty-three eyes were included in the macroarchitectural analysis. Instrumentation utilized for membrane peeling included forceps alone for 73 eyes (45%), combined diamond-dusted membrane scraper (DDMS) and forceps for 87 eyes (53%), and other techniques in three eyes (2%). Focal retinal elevations were identified in 45 of 163 eyes (28%). Video/iOCT correlation identified 69% of alterations involved forceps compared to 26% due to DDMS. Sixteen percent of retinal alterations persisted 1 month following surgery. The microarchitectural analysis included 134 eyes. Immediately following membrane peeling, there was a significant increase in the ellipsoid zone to retinal pigment epithelium height (þ20%, P < 0.00001) and the cone outer segment tips to retinal pigment epithelium height (þ18%, P < 0.00001).CONCLUSIONS. Significant subclinical retinal architectural changes occur during membrane peeling for VMI conditions. Differences in surgical instruments may impact these architectural alterations.

show abstract

Section: Discussionmentioning

confidence: 99%

Membrane Peeling-Induced Retinal Alterations on Intraoperative OCT in Vitreomacular Interface Disorders From the PIONEER Study

Ehlers

Han

Petkovsek

et al. 2015

Invest. Ophthalmol. Vis. Sci.

View full text Add to dashboard Cite

show abstract

“…19,20 We performed ILM peeling in RRD patients and noted that forceps might press the attached retina against the choroid and sclera without macular detachment, whereas the forceps might not press the free-floating retina with macular detachment. Threedimensional OCT clearly visualized time-dependent retinal changes in the wide-field comprehensive topography, which were sometimes difficult to observe with the conventional cross-sectional OCT. To test the mechanical insult that causes the retinal structural changes after ILM peeling, we hypothesized that ILM forceps may induce the changes in part by pressing and grasping the ILM and inner structures of the retina.…”

mentioning

confidence: 99%

Internal Limiting Membrane Peeling–dependent Retinal Structural Changes After Vitrectomy in Rhegmatogenous Retinal Detachment

Hisatomi

Tachibana

Notomi

et al. 2018

Retina

View full text Add to dashboard Cite

show abstract

“…Subtle superficial retinal hemorrhages are reported to be encountered in 66% to 75% of patients as ILM peeled with either a diamond-dusted membrane scraper or forceps. 12 These hemorrhages usually are self-limited, which do not appear to have long-term implications. 13 There have been rare reports of more serious issues during ILM peeling, such as significant intraoperative bleeding from small retinal vessel damage that may result in postoperative hyphema with high intraocular pressure.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Retinal Architectural Changes Using Intraoperative OCT Following Surgical Manipulations With Membrane Flex Loop in the DISCOVER Study

Uchida

Srivastava

Ehlers

2017

Invest. Ophthalmol. Vis. Sci.

View full text Add to dashboard Cite

PurposeWe investigate acute retinal alterations identified on intraoperative optical coherence tomography (iOCT) immediately following surgical intervention with the Finesse Flex Loop for vitreoretinal interface disorders.MethodsThe Determination of feasibility of Intraoperative Spectral domain microscope Combined/integrated OCT Visualization during En face Retinal and ophthalmic surgery (DISCOVER) study is a prospective multisurgeon intraoperative OCT clinical study. Subjects who had participated in the DISCOVER study and had undergone macular surgery with the membrane flex loop from August 2014 to July 2016 were identified. iOCT images and video sequences were evaluated at various surgical time points. Subjects were excluded if iOCT images were not obtained over the area of membrane peeling performed with the membrane flex loop. Qualitative characteristics of intraoperative changes in retinal images were analyzed, with particular focus on the retinal layers within the bed of membrane peeling performed specifically with the membrane flex loop.ResultsWe studied 34 eyes of 34 patients, with a mean age of 72.7 (± 6.4) years, 25 of whom were women. The intraoperative diagnosis was full thickness macular hole in 21 eyes (62%) and epiretinal membrane in 13 (38%). All eyes had successful indocyanine green–assisted inner limiting membrane (ILM) flap initiation using the membrane loop. Intraoperative OCT demonstrated expansion of the ellipsoid zone-to-RPE distance in 3 eyes (9%), definitive subretinal fluid accumulation in 1 eye (3%), and hyperreflectivity of the inner retinal layers associated with retinal hemorrhage in 10 eyes (29%). Retinal breaks were not observed in any eye.ConclusionsAcute retinal alterations after ILM peeling with the membrane flex loop were visualized at a frequency of less than 10%. Additional research is needed to understand the clinical impact, if any, of these architectural alterations.

show abstract

ILM peeling technique influences the degree of a dissociated optic nerve fibre layer appearance after macular hole surgery

Abstract: ILM peeling technique and possibly other surgeon-specific factors appear to influence the extent of DONFL observed after ILM peeling macular hole surgery.

Cited by 43 publications

References 25 publications

Membrane Peeling-Induced Retinal Alterations on Intraoperative OCT in Vitreomacular Interface Disorders From the PIONEER Study

Membrane Peeling-Induced Retinal Alterations on Intraoperative OCT in Vitreomacular Interface Disorders From the PIONEER Study

Internal Limiting Membrane Peeling–dependent Retinal Structural Changes After Vitrectomy in Rhegmatogenous Retinal Detachment

Analysis of Retinal Architectural Changes Using Intraoperative OCT Following Surgical Manipulations With Membrane Flex Loop in the DISCOVER Study

Contact Info

Product

Resources

About