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Clinical science
iOCT-assisted macular hole surgery: outcomes and utility from the DISCOVER study
  1. Philina Yee1,
  2. Duriye Damla Sevgi1,
  3. Joseph Abraham1,
  4. Sunil K Srivastava1,2,
  5. Thuy Le1,
  6. Atsuro Uchida1,
  7. Natalia Figueiredo1,
  8. Aleksandra V Rachitskaya2,
  9. Sumit Sharma2,
  10. Jamie Reese1,
  11. Justis P Ehlers1,2
  1. 1 The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland, Ohio, USA
  2. 2 Cole Eye Institute Retina Service, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Justis P Ehlers, Cole Eye Institute, Cleveland, OH 44106, USA; ehlersj1{at}yahoo.com

Abstract

Background/aims This study aimed to characterise the clinical outcomes and utility of intraoperative optical coherence tomography (iOCT)-assisted macular hole (MH) repair.

Methods This was a post hoc analysis of eyes in the D etermination of feasibility of I ntraoperative S pectral domain microscope C ombined/integrated O CT V isualization during E n face R etinal and ophthalmic surgery (DISCOVER) study undergoing surgical MH repair with use of iOCT. Functional and surgical outcome data were collected through 12 months postoperatively. MH closure rate, postoperative visual acuity (VA), percentage of cases in which iOCT provided valuable feedback and altered surgical decision making were measured.

Results Eighty-four eyes were included in this study. The mean preoperative VA measured 20/114. The mean postoperative VA improved to 20/68 (p<0.001) at month 1, 20/48 (p<0.001) at month 3 and 20/45 (p<0.001) at month 12 or later. In 43 cases (51%), surgeons reported that iOCT provided valuable information (eg, confirming release of vitreomacular traction and identification of occult residual membranes). In 10 cases (12%), iOCT data specifically altered surgical decision making. Postoperative day 1 transtamponade OCT confirmed tissue apposition and apparent hole closure in 74% of eyes (21/26). All five open holes on postoperative day 1 closed following positioning. Single-surgery MH closure was achieved in 97.6% of cases. One persistent MH was successfully closed with a subsequent surgical repair for a final overall closure rate of 98.8%. Due to chronicity and MH size, additional repair was not recommended for the single remaining persistent MH.

Conclusion This study suggests that iOCT may have important utility in MH surgery, including impacting surgical decision making. iOCT-assisted MH surgery resulted in significant improvement in VA and high single-surgery success rate.

  • macula
  • treatment surgery
  • imaging

https://doi.org/10.1136/bjophthalmol-2020-316045

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    Footnotes

    • Correction notice This paper has been corrected since it was published online. Author Jamie Reese's affiliation was missing.

    • Contributors All authors participated in data collection, review and manuscript revision. PY initially drafted the manuscript. JPE and SKS provided supervision and funding support.

    • Funding National Institutes of Health/National Eye Institute, Bethesda, Maryland, USA, K23-EY022947-01A1 (JPE).

    • Competing interests There are no direct competing interests, but some of the authors do have financial disclosures. SSr is a consultant for Bausch and Lomb, Carl Zeiss Meditec and Leica; a researcher for Allergan and Bausch and Lomb; and has a patent licensed to Leica. SSh is a consultant for Eyepoint. AVR is a consultant for Allergan, Alcon and Zeiss and is a speaker for Novartis. JPE is a consultant for Alcon, Allergan, Leica, Santen, Thrombogenics, Genentech, Novartis, Aerpio, Allegro, Regeneron, Roche and Zeiss; has intellectual property licensed to Leica; and receives research support from Alcon, Genentech, Regeneron, Boehringer-Ingelheim, Novartis, Aerpio and Thrombogenics. The following authors have no financial disclosures: PY, AU, DDS, JA, TL and JR.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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