Intraoperative Observation of a Macular Holes Using Optical Coherence Tomography

Abstract

Purpose This study aimed to observe intraoperative changes in macular hole (MH) form using intraoperative optical coherence tomography (iOCT). Methods A total of 10 eyes from 10 patients with MH who underwent vitrectomy using iOCT from May 2015 to October 2015 at the Yamagata University Hospital were retrospectively evaluated. Accordingly, 25-gauge pars plana vitrectomy using iOCT with internal limiting membrane (ILM) peeling and sulfur hexafluoride gas tamponade was performed on each patient. During surgery, MHs were observed using iOCT over four points, namely, before posterior vitreous detachment (PVD) formation, after PVD formation, after ILM peeling, and after fluid–gas exchange. Thereafter, basal MH diameter and minimum aperture MH diameter were postoperatively analyzed. Results Before PVD formation, after PVD formation, after ILM peeling, and after fluid–gas exchange, the mean basal MH diameters were 690.7 ± 268.4, 683.3 ± 274.2, 683.7 ± 269.5, and 668.3 ± 261.4 μm, while the mean minimum aperture MH diameters were 278.3 ± 165.2, 283.0 ± 170.2, 257.0 ± 127.8, and 188.0 ± 105.0 μm, respectively. The mean minimum aperture MH diameter decreased significantly after fluid–gas exchange (one-way repeated measures ANOVA, p < 0.05). None of the patients exhibited intraoperative closure of the MHs. However, MH closure was confirmed in all patients after the surgery. Conclusion None of the patients demonstrated intraoperative MHs closure. Accordingly, the minimum aperture MH diameter was the first change formation to close after fluid–gas exchange.

Intraoperative Optical Coherence Tomography in the Management of Macular Holes: State of the Art and Future Perspectives

“…These results allow us to expect that more significant intraoperative changes in FTMH morphology might reflect an increased hole laxity and indicate an increase in the probability of FTMH closure. Their results might be considered only partially coherent with the subsequent study by Riazi-Esfahani et al [ 27 ] and Nishitsuka et al [ 17 ], who also found a decrease in the inner area of the FTMHs post-ILM peeling, whereas they found no increase in the base diameter. Furthermore, Nishitsuka et al described that the mean minimum diameter of FTMH decreased significantly after fluid–gas exchange, highlighting the importance of gas-surface tension, even though the patients did not demonstrate intraoperative FTMH closure.…”

“…Nishitsuka et al aimed at observing intraoperative changes in FTMH morphology using iOCT [ 17 ]. They included 10 eyes from 10 patients undergoing surgical treatment for FTMH detected intraoperatively by the Rescan™ 700 system (Carl Zeiss Meditech, Oberkochen, Germany).…”

The State of Intraoperative OCT in Vitreoretinal Surgery: Recent Advances and Future Challenges

“…Moreover, in a recent report by Nishitsuka and colleagues, hole diameter was measured through iOCT at different surgical stages, showing a decrease after ILM peeling and a further reduction after gas tamponading, probably due to the centripetal surface tension force between the retina and the gas bubble [39]. The ability of iOCT to observe the macular hole changes intraoperatively may also affect the recommendations for postoperative face-down positioning protocols.…”