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  • Use of iOCT to Guide ERM Peeling

    By Jean Shaw
    Selected by Andrew P. Schachat, MD
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    Journal Highlights

    Ophthalmology Retina, December 2021

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    Tuifua et al. compared outcomes of intraoperative OCT (iOCT)–guided epiretinal membrane (ERM) peeling with those achieved with the conven­tional approach (pars plana vitrectomy plus ERM peel). They found that the two procedures produced similar visual acuity (VA) and anatomic results.

    For this retrospective case-control study, the authors assessed 262 eyes. Of these, 151 were in the iOCT cohort, and 111 underwent conventional surgery. Main outcome measures were VA and ERM recurrence. In addition, central subfield thickness (CST) and re­operation rates were assessed. Of note, those who underwent iOCT-guided peeling had participated in a separate prospective study that evaluated the use of microscope-integrated iOCT in ocular surgery.

    Results were as follows:

    • VA. Pre-op VA was 20/55 (mean ± standard deviation, 62.8 ± 12.1 letters) in the iOCT group and 20/50 (64.9 ± 9.9 letters) in the conventional group. At 12 months after surgery, VA had improved by 11.9 letters in the iOCT cohort and by 12.1 letters in those who underwent conventional surgery.
    • CST. Mean CST decreased from 466.8 ± 7.9 μm at baseline to 367.3 ± 6.0 μm at 12 months in the iOCT group. Those in the conventional group experienced a similar reduction, with baseline CST of 454.2 ± 10.3 μm decreasing to 360.9 ± 6.3 μm at 12 months.
    • ERM recurrence. No visually signif­icant foveal ERMs recurred in either cohort. When both the parafoveal and foveal areas were assessed, ERM re­currence or persistence was visible in 63 eyes (42%) in the iOCT group and in 30 eyes (27%) in the conventional group. In using iOCT, the surgeons were able to identify those eyes that required additional peeling for residual membranes (n = 29). Moreover, in 15 eyes, although the surgeon initially thought that the peel was not complete, iOCT was able to confirm that it was successful. As a result, these eyes were spared any further use of dyes for addi­tional peeling and tissue manipulation.
    • Reoperations. No patients in either group required reoperation related to ERM peeling. However, cataract sur­gery was needed in four patients, three of whom were in the iOCT group, as cataract progression was noted.

    These findings warrant randomized, prospective studies with longer follow-up to fully assess the role of iOCT in ERM surgery, the authors said.

    The original article can be found here.