Ophthalmologica

Research Article

Intraoperative Optical Coherence Tomography-Guided Membrane Peeling for Surgery of Macular Pucker: Advantages and Limitations

Leisser C. · Hirnschall N. · Palkovits S. · Doeller B. · Kefer K. · Findl O.

Author affiliations

Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria

Keywords: 23G vitrectomyIntraoperative optical coherence tomographyPeeling without staining

Related Articles for ""
Ophthalmologica 2019;241:234–240
https://doi.org/10.1159/000493279

Log in to MyKarger to check if you already have access to this content.




Forgot your password
Sign up to MyKarger

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more
CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!


If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00

Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates

Select
* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Research Article

Received: March 02, 2018
Accepted: August 27, 2018
Published online: November 09, 2018
Issue release date: April 2019

Number of Print Pages: 7
Number of Figures: 4
Number of Tables: 0

ISSN: 0030-3755 (Print)
eISSN: 1423-0267 (Online)

For additional information: https://www.karger.com/OPH

Abstract

Purpose: Epiretinal membranes (ERMs) are a disorder leading to progressive vision loss and metamorphopsia. The gold standard in therapy is vitrectomy with membrane peeling. The aim of this study was to assess whether the use of intraoperative optical coherence tomography (iOCT), which allows tomographic visualization of the membrane during peeling, enables peeling without staining. Methods: This prospective study included 30 eyes of 30 patients with idiopathic ERMs scheduled for surgery. Pars plana vitrectomy with iOCT was performed in all cases, whereas staining of ERMs was only performed if needed. Internal limiting membrane (ILM) peeling was performed in case of wrinkled retinal surface after peeling of ERMs. Results: In 63% (n = 19) eyes the ERM could be peeled successfully without use of staining. Nevertheless, in 89% (n = 17) of patients having had ERM peeling without dye, staining of the ILM was performed afterwards for peeling the ILM. Best corrected visual acuity improved in 80% (n = 24) and remained unchanged in 7% (n = 2) 3 months after surgery. There were no significant differences in postoperative results between patients with and without staining for ERM peeling. Conclusions: Use of iOCT helps to complete ERM peeling in a majority of cases without use of a chromovitrectomy dye, but as iOCT fails to visualize the ILM, chromovitrectomy still facilitates macular surgery in a majority of cases.

© 2018 S. Karger AG, Basel



Related Articles:

References

  1. Zhao F, Gandorfer A, Haritoglou C, Scheler R, Schaumberger MM, Kampik A, et al. Epiretinal cell proliferation in macular pucker and vitreomacular traction syndrome: analysis of flat-mounted internal limiting membrane specimens. Retina. 2013 Jan;33(1):77–88.
    External Resources
  2. Kohno RI, Hata Y, Kawahara S, Kita T, Arita R, Mochizuki Y, et al. Possible contribution of hyalocytes to idiopathic epiretinal membrane formation and its contraction. Br J Ophthalmol. 2009 Aug;93(8):1020–6.
    External Resources
  3. Mitamura Y, Hirano K, Baba T, Yamamoto S. Correlation of visual recovery with presence of photoreceptor inner/outer segment junction in optical coherence images after epiretinal membrane surgery. Br J Ophthalmol. 2009 Feb;93(2):171–5.
    External Resources
  4. Oster SF, Mojana F, Brar M, Yuson RM, Cheng L, Freeman WR. Disruption of the photoreceptor inner segment/outer segment layer on spectral domain-optical coherence tomography is a predictor of poor visual acuity in patients with epiretinal membranes. Retina. 2010 May;30(5):713–8.
    External Resources
  5. Shimozono M, Oishi A, Hata M, Matsuki T, Ito S, Ishida K, et al. The significance of cone outer segment tips as a prognostic factor in epiretinal membrane surgery. Am J Ophthalmol. 2012 Apr;153(4):698–704.
    External Resources
  6. Machemer R. [The surgical removal of epiretinal macular membranes (macular puckers) (author’s transl)]. Klin Monbl Augenheilkd. 1978 Jul;173(1):36–42.
    External Resources
  7. Kadonosono K, Itoh N, Uchio E, Nakamura S, Ohno S. Staining of internal limiting membrane in macular hole surgery. Arch Ophthalmol. 2000 Aug;118(8):1116–8.
    External Resources
  8. Gandorfer A, Haritoglou C, Gass CA, Ulbig MW, Kampik A. Indocyanine green-assisted peeling of the internal limiting membrane may cause retinal damage. Am J Ophthalmol. 2001 Sep;132(3):431–3.
    External Resources
  9. Haritoglou C, Gandorfer A, Gass CA, Schaumberger M, Ulbig MW, Kampik A. Indocyanine green-assisted peeling of the internal limiting membrane in macular hole surgery affects visual outcome: a clinicopathologic correlation. Am J Ophthalmol. 2002 Dec;134(6):836–41.
    External Resources
  10. Haritoglou C, Gandorfer A, Gass CA, Schaumberger M, Ulbig MW, Kampik A. The effect of indocyanine-green on functional outcome of macular pucker surgery. Am J Ophthalmol. 2003 Mar;135(3):328–37.
    External Resources
  11. Uemura A, Kanda S, Sakamoto Y, Kita H. Visual field defects after uneventful vitrectomy for epiretinal membrane with indocyanine green-assisted internal limiting membrane peeling. Am J Ophthalmol. 2003 Aug;136(2):252–7.
    External Resources
  12. Ho JD, Chen HC, Chen SN, Tsai RJ. Reduction of indocyanine green-associated photosensitizing toxicity in retinal pigment epithelium by sodium elimination. Arch Ophthalmol. 2004 Jun;122(6):871–8.
    External Resources
  13. Cheng SN, Yang TC, Ho JD, Hwang JF, Cheng CK. Ocular toxicity of intravitreal indocyanine green. J Ocul Pharmacol Ther. 2005 Feb;21(1):85–93.
    External Resources
  14. Yamashita T, Uemura A, Kita H, Nakao K, Sakamoto T. Long-term outcomes of visual field defects after indocyanine green-assisted macular hole surgery. Retina. 2008 Oct;28(9):1228–33.
    External Resources
  15. von Jagow B, Höing A, Gandorfer A, Rudolph G, Kohnen T, Kampik A, et al. Functional outcome of indocyanine green-assisted macular surgery: 7-year follow-up. Retina. 2009 Oct;29(9):1249–56.
    External Resources
  16. Kernt M, Hirneiss C, Wolf A, Liegl R, Rueping J, Neubauer A, et al. Indocyanine green increases light-induced oxidative stress, senescence, and matrix metalloproteinases 1 and 3 in human RPE cells. Acta Ophthalmol. 2012 Sep;90(6):571–9.
    External Resources
  17. Veckeneer M, van Overdam K, Monzer J, Kobuch K, van Marle W, Spekreijse H, et al. Ocular toxicity study of trypan blue injected into the vitreous cavity of rabbit eyes. Graefes Arch Clin Exp Ophthalmol. 2001 Sep;239(9):698–704.
    External Resources
  18. Perrier M, Sébag M. Epiretinal membrane surgery assisted by trypan blue. Am J Ophthalmol. 2003 Jun;135(6):909–11.
    External Resources
  19. Stalmans P, Van Aken EH, Melles G, Veckeneer M, Feron EJ, Stalmans I. Trypan blue not toxic for retinal pigment epithelium in vitro. Am J Ophthalmol. 2003 Feb;135(2):234–6.
    External Resources
  20. Teba FA, Mohr A, Eckardt C, Wong D, Kusaka S, Joondeph BC, et al. Trypan blue staining in vitreoretinal surgery. Ophthalmology. 2003 Dec;110(12):2409–12.
    External Resources
  21. Haritoglou C, Eibl K, Schaumberger M, Mueller AJ, Priglinger S, Alge C, et al. Functional outcome after trypan blue-assisted vitrectomy for macular pucker: a prospective, randomized, comparative trial. Am J Ophthalmol. 2004 Jul;138(1):1–5.
    External Resources
  22. Tao YK, Ehlers JP, Toth CA, Izatt JA. Intraoperative spectral domain optical coherence tomography for vitreoretinal surgery. Opt Lett. 2010 Oct;35(20):3315–7.
    External Resources
  23. Binder S, Falkner-Radler CI, Hauger C, Matz H, Glittenberg C. Feasibility of intrasurgical spectral-domain optical coherence tomography. Retina. 2011 Jul–Aug;31(7):1332–6.
    External Resources
  24. Ehlers JP, Tao YK, Farsiu S, Maldonado R, Izatt JA, Toth CA. Integration of a spectral domain optical coherence tomography system into a surgical microscope for intraoperative imaging. Invest Ophthalmol Vis Sci. 2011 May;52(6):3153–9.
    External Resources
  25. Hahn P, Migacz J, O’Connell R, Izatt JA, Toth CA. Unprocessed real-time imaging of vitreoretinal surgical maneuvers using a microscope-integrated spectral-domain optical coherence tomography system. Graefes Arch Clin Exp Ophthalmol. 2013 Jan;251(1):213–20.
    External Resources
  26. Hahn P, Migacz J, O’Donnell R, Day S, Lee A, Lin P, et al. Preclinical evaluation and intraoperative human retinal imaging with a high-resolution microscope-integrated spectral domain optical coherence tomography device. Retina. 2013 Jul–Aug;33(7):1328–37.
    External Resources
  27. Ehlers JP, Kaiser PK, Srivastava SK: Intraoperative optical coherence tomography using the RESCAN 700: preliminary results from the DISCOVER study. Br J Ophthalmol. 2014 Oct;98(10):1329–32.
  28. Ehlers JP, Srivastava SK, Feiler D, Noonan AI, Rollins AM, Tao YK. Integrative advances for OCT-guided ophthalmic surgery and intraoperative OCT: microscope integration, surgical instrumentation, and heads-up display surgeon feedback. PLoS One. 2014 Aug;9(8):e105224.
    External Resources
  29. Falkner-Radler CI, Glittenberg C, Gabriel M, Binder S. Intrasurgical microscope-integrated spectral domain optical coherence tomography-assisted membrane peeling. Retina. 2015 Oct;35(10):2100–6.
    External Resources
  30. Pfau M, Michels S, Binder S, Becker MD. Clinical Experience With the First Commercially Available Intraoperative Optical Coherence Tomography System. Ophthalmic Surg Lasers Imaging Retina. 2015 Nov–Dec;46(10):1001–8.
    External Resources
  31. Leisser C, Hackl C, Hirnschall N, Luft N, Döller B, Draschl P, et al. Visualizing Macular Structures During Membrane Peeling Surgery With an Intraoperative Spectral-Domain Optical Coherence Tomography Device. Ophthalmic Surg Lasers Imaging Retina. 2016 Apr;47(4):328–32.
    External Resources
  32. Ehlers JP, Modi YS, Pecen PE, Goshe J, Dupps WJ, Rachitskaya A, et al. The DISCOVER Study 3-Year Results: Feasibility and Usefulness of Microscope-Integrated Intraoperative OCT during Ophthalmic Surgery. Ophthalmology. 2018 Jul;125(7):1014–27.
  33. Ehlers JP, Khan M, Petkovsek D, Stiegel L, Kaiser PK, Singh RP, et al. Outcomes of Intraoperative OCT-Assisted Epiretinal Membrane Surgery from the PIONEER Study. Ophthalmol Retina. 2018 Apr;2(4):263–7.
    External Resources
  34. Liu H, Zuo S, Ding C, Dai X, Zhu X. Comparison of the Effectiveness of Pars Plana Vitrectomy with and without Internal Limiting Membrane Peeling for Idiopathic Retinal Membrane Removal: A Meta-Analysis. J Ophthalmol. 2015;2015:974568.
    External Resources
  35. Chang WC, Lin C, Lee CH, Sung TL, Tung TH, Liu JH. Vitrectomy with or without internal limiting membrane peeling for idiopathic epiretinal membrane: A meta-analysis. PLoS One. 2017 Jun;12(6):e0179105.
    External Resources
  36. Ripandelli G, Scarinci F, Piaggi P, Guidi G, Pileri M, Cupo G, et al. Macular pucker: to peel or not to peel the internal limiting membrane? A microperimetric response. Retina. 2015 Mar;35(3):498–507.
    External Resources
  37. Hida T, Chandler D, Arena JE, Machemer R. Experimental and clinical observations of the intraocular toxicity of commercial corticosteroid preparations. Am J Ophthalmol. 1986 Feb;101(2):190–5.
    External Resources
  38. Yeung CK, Chan KP, Chiang SW, Pang CP, Lam DS. The toxic and stress responses of cultured human retinal pigment epithelium (ARPE19) and human glial cells (SVG) in the presence of triamcinolone. Invest Ophthalmol Vis Sci. 2003 Dec;44(12):5293–300.
    External Resources
  39. Narayanan R, Mungcal JK, Kenney MC, Seigel GM, Kuppermann BD. Toxicity of triamcinolone acetonide on retinal neurosensory and pigment epithelial cells. Invest Ophthalmol Vis Sci. 2006 Feb;47(2):722–8.
    External Resources
  40. Szurman P, Kaczmarek R, Spitzer MS, Jaissle GB, Decker P, Grisanti S, et al. Differential toxic effect of dissolved triamcinolone and its crystalline deposits on cultured human retinal pigment epithelium (ARPE19) cells. Exp Eye Res. 2006 Sep;83(3):584–92.
    External Resources
  41. Szurman P, Sierra A, Kaczmarek R, Jaissle GB, Wallenfels-Thilo B, Grisanti S, et al. Different biocompatibility of crystalline triamcinolone deposits on retinal cells in vitro and in vivo. Exp Eye Res. 2007 Jul;85(1):44–53.
    External Resources
  42. Almeida FP, De Lucca AC, Scott IU, Jorge R, Messias A. Accidental subretinal brilliant blue G migration during internal limiting membrane peeling surgery. JAMA Ophthalmol. 2015 Jan;133(1):85–8.
    External Resources
  43. Ando F, Yasui O, Hirose H, Ohba N. Optic nerve atrophy after vitrectomy with indocyanine green-assisted internal limiting membrane peeling in diffuse diabetic macular edema. Adverse effect of ICG-assisted ILM peeling. Graefes Arch Clin Exp Ophthalmol. 2004 Dec;242(12):995–9.
    External Resources
  44. Leisser C, Hirnschall N, Hackl C, Döller B, Varsits R, Ullrich M, et al. Risk factors for postoperative intraretinal cystoid changes after peeling of idiopathic epiretinal membranes among patients randomized for balanced salt solution and air-tamponade. Acta Ophthalmol. 2018 Feb;96(4):e439–44.
    External Resources
  45. Frisina R, Pinackatt SJ, Sartore M, Monfardini A, Baldi A, Cesana BM, et al. Cystoid macular edema after pars plana vitrectomy for idiopathic epiretinal membrane. Graefes Arch Clin Exp Ophthalmol. 2015 Jan;253(1):47–56.
    External Resources

Article / Publication Details

First-Page Preview
Abstract of Research Article

Received: March 02, 2018
Accepted: August 27, 2018
Published online: November 09, 2018
Issue release date: April 2019

Number of Print Pages: 7
Number of Figures: 4
Number of Tables: 0

ISSN: 0030-3755 (Print)
eISSN: 1423-0267 (Online)

For additional information: https://www.karger.com/OPH

Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Article Tools
Article Details

2019, Vol.241, No. 4

April 2019

Article

Recommend This
TOP