Authors
Kovalev S.A., Ivanishko Y.A., Miroshnikov V.V.
Eye clinic «InterYUNA», Rostov-on-Don
Abstract
Rationale: The aim of this work was to outline general approaches and describe individual OCT signs that are important when planning macular surgery. Literature data and own experience were summarized, the relationship between the preoperative OCT-data and the features of the VMI disorders surgery was revealed.
Results: The vitreoretinal surgeon must have the skills and the ability to analyze the results of the study directly at the device or using a remote review station. In the protocol for examining a patient with VMI pathology, in addition to linear sections through the center of the fovea, it is necessary to include a mode that allows the retina to be assessed layer by layer (en face), which eliminates the possibility of underestimating the severity of structural changes. For a patient with VMT syndrome, a reasonable approach would be OCT monitoring on the day of surgery to assess dynamics. With this pathology, OCT in 3D mode allows to localize “weak” areas where it is necessary to exclude traction; and use the gentlest technique possible. In ERM surgery, en face OCT allows one to localize the area of greatest diastasis of the ERM and retina, simplifying the initial capture of the ERM with forceps. In addition, OCT allows us to identify certain types of ERM that require special tactics. There is a pathognomonic OCT sign that showing the area of the removed ILM, this is dissociation of the nerve fiber layer.
Conclusions: OCT is the most important diagnostic tool in the practice of a vitreoretinal surgeon. Self-analysis of OCT-data using en face mode immediately prior to intervention can make macular surgery safer, more precise, more efficient, and more predictable.
Keywords: optical coherence tomography, OCT, macula, vitreomacular interface, VMI, VMT, ERM, vitreoretinal surgery.
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