Intraoperative Three-Dimensional Fluorescein Angiography-Guided Pars Plana Vitrectomy for the Treatment of Proliferative Diabetic Retinopathy: The Maximized Utility of the Digital Assisted Vitrectomy

Abstract

Purpose: To show the usefulness of the intraoperative three-dimensional fluorescein angiography (3D-FA)-guided pars plana vitrectomy.Methods: The NGENUITY 3D visualization system was used for the digital assisted vitrectomy. Three-dimensional fluorescein angiography-guided pars plana vitrectomy was performed in three patients with vitreous hemorrhage secondary to proliferative diabetic retinopathy. We investigated both whether several angiographic findings can be successfully displayed on the screen during 3D-FA and whether pars plana vitrectomy can be performed simultaneously on the same screen while implementing 3D-FA.Results: In all cases, the abnormal FA findings including hypofluorescence due to nonperfusion areas, and the hyperfluorescence due to macular edema and fibrovascular proliferative membrane were successfully displayed on the screen. The segmentation and delamination of fibrovascular proliferative membrane and panretinal photocoagulation for detected nonperfusion areas were able to be performed on the same screen while implementing 3D-FA.Conclusion: Three-dimensional fluorescein angiography-guided pars plana vitrectomy is a novel approach that fully utilizes the advantages of digital assisted vitrectomy and a promising option for the treatment of proliferative diabetic retinopathy.

Intraoperative Three-Dimensional Fluorescein Angiography–guided Pars Plana Vitrectomy for Branch Retinal Vein Occlusion

“…In a previous report, 3D-FA-guided PPV made it possible to add the correct amount of retinal photocoagulation to NPA and identify the accurate size and orientation of active FVPMs in cases of proliferative diabetic retinopathy. 3 Similarly, in this study, the range of NPA secondary to BRVO was accurately identified, enabling additional performance of retinal photocoagulation with the sufficient and necessary number. It was also possible to perform maneuvers such as delamination and dissection of FVPMs while identifying the size and location of NVEs.…”

“…The previous and present studies clearly demonstrate that the 3D-FA is particularly useful for the treatment of ischemic retinal diseases, including BRVO with NVE. 3 Retinal vein occlusion sometimes develops into neovascularization on the disk and elsewhere, with traction retinal detachment, rhegmatogenous retinal detachment, epiretinal membrane, and VH, which requires PPV for the treatment. [4][5][6][7][8][9][10] Reports have shown that the outcomes of PPV are better when eyes underwent retinal photocoagulation in the NPA and had complete posterior vitreous detachment compared with only partial detachment.…”

“…The detail setting of imaging modes in the NGENUITY 3D visualization system (Alcon, Fort Worth, TX) for both PPV and 3D-FA were setup as described in Table 1 with minor modifications to the settings in the previous report. 3 Briefly, before 3D-FA, the standard 27-gauge (27 G) PPV with a noncontact wide-angle viewing system (Resight; Carl Zeiss Meditec AG, Jena, Germany) using the NGENUITY 3D visualization system (Alcon, Fort Worth, TX) was performed under sub-Tenon anesthesia with approximately 4 mL of 2% lidocaine in all cases. For 3D-FA, an interference barrier filter (SD-FAG-Z; Scimen Design Ltd, Tokyo, Japan) was adapted to the operating microscope (OPMI LUMERA 700; Carl Zeiss Meditec, Germany), and 27-G light pipe (27-G midfield endoilluminator, Synergetics, Inc, O'Fallon, MO) connected to the excitation filter (FAG filter, Scimen Design Ltd, Tokyo, Japan)-mounted light source (Photon II, Synergetics, Inc, O'Fallon, MO) was used for intraocular illumination during 3D-FA-guided PPV.…”

“…We have recently reported a new technique using DAV termed intraoperative 3D fluorescein angiography (3D-FA). 3 This method enables us to capture real-time 3D-FA imaging during surgery, and the operation can be performed with a contrast imaging, allowing for minimally invasive and reliable surgery. In this article, we report the effectiveness of this technique for branch retinal vein occlusion (BRVO) with vitreous hemorrhage (VH) and neovascularization elsewhere (NVE).…”

Volume‐rendered optical coherence tomography angiography during ocular interventions: Advocating for noninvasive intraoperative retinal perfusion monitoring

“…[1,2] Recent evidence supports particularly three-dimensionally (3D) visualized FA for clinical use. [3,4] However, intraoperative applicability of FA is limited given the complicated arrangement, invasiveness, associated risks, side effects, and the lack of objective/ automated vessel quantification, calling for alternative and more feasible techniques that lend themselves to be utilized day-to-day in the clinic.…”