INTRAOPERATIVE OCT

Intraoperative OCT image. Courtesy of Nikolaos E Bechrakis MD, FEBO

Intraoperative optical coherence tomography (OCT) and small-gauge, high-speed vitrectomy can enhance the success rate in a variety of retinal procedures, said Nikolaos E Bechrakis MD, FEBO at the 15th EURETINA Congress in Nice, France.

Dr Bechrakis described his experience from a one-week trial of intraoperative OCT using the RESCAN 700 (ZEISS), and also from one year’s experience with 27-gauge high-speed vitrectomy.

Using video clips from his surgery, he showed how intraoperative OCT enabled visualisation of the progress of surgery during procedures such as inner limiting membrane peeling, retrieval of lens fragments in an eye with a lens subluxated during cataract surgery, and removal of epiretinal membranes.

He also demonstrated how, in an eye with proliferative vitreoretinopathy, intraoperative OCT provided clear visualisation of the epiretinal membrane and the flattening of the retina following injection of perfluorocarbon liquid, showing residual undulations in the outer retina. Following fluid-air exchange, the return of subretinal fluid to the macula was also clearly visualised, as was the re-flattening of the retina following silicone oil injection.

HIGH-SPEED

Dr Bechrakis also showed some clips of his experience with 27-gauge surgery using a high-speed, 7,500 cuts-per-minute vitreous cutter. He and his associates have adopted the new technologies since December 2014, when they first became available. He noted that grasping an epiretinal membrane can be slightly more difficult with the 27-gauge cutter. He therefore first opens the membrane with the forceps and then performs a vitrector-assisted peeling.

“This is very elegant and gives you a lot of control of peeling, without producing too much traction over the tissues. However, you need a flap of membrane tissue large enough to occlude the opening of your vitrector,” said Dr Bechrakis, Professor and Chairman, Department of Ophthalmology, Innsbruck Medical University, Austria.

Small-gauge surgery can also be used in complicated cases such as a retinal detachment. He noted that he has found it easy to perform such surgery bimanually with indentation, although 27-gauge instruments are more flexible compared to 23-gauge. In the first series of 27-gauge vitrectomy for primary rhegmatogenous retinal detachment, they have had an 85 per cent primary attachment rate after a follow-up of five to nine months.

“I think high-speed, small-gauge vitrectomy can give you a lot of safety and good control over tissue manipulation and it is very efficacious surgery,” added Dr Bechrakis.

Nikolaos E Bechrakis:
nikolaos.bechrakis@i-med.ac.at