Sponsored by Carl Zeiss
BY Mahi Muqit, MD
Mahi Muqit PhD FRCOphth is a Consultant Ophthalmologist, Cataract and Vitreoretinal Surgeon at Moorfields Eye Hospital, and an Honorary Clinical Lecturer at the Institute of Ophthalmology at UCL, London. His research interests include diabetic retinopathy, vitreoretinal surgery, artificial retinal prosthesis, OCT and retinal laser.
A 78 year-old female had failed phacovitrectomy, internal limiting membrane (ILM) peel with C3F8 gas surgery for a very large full-thickness macular hole (FTMH). She underwent revisional vitrectomy surgery for an open hole.
Planned Treatment Without Intraoperative OCT
During 23-G vitrectomy surgery without OCT, there were no obvious signs of residual ILM identified using macular blue stain.
Treatment With Intraoperative OCT
The OPMI LUMERA 700 and intraoperative OCT RESCAN 700 from ZEISS was essential to assist in visualization of the remnants of ILM that were inducing persisting traction and keeping the macular hole open. A collar of residual ILM was located at the edge of the macular hole using intraoperative OCT guidance, and the ILM tissue was removed successfully with intraoperative OCT. The technique of localized foveal retinal detachment using balance salt solution was performed but the endpoint of raised macular hole edges was difficult to judge. The intraoperative OCT system supported accurate calculation of the size of foveal retinal detachment. The raised edges of the FTMH were significantly elevated at the end of surgery to maximize the chances of hole closure and the maximum diameter of the FTMH assessed. Based on the intraoperative size of the macular hole using intraoperative OCT, a short-acting gas bubble was used for the surgery. The FTMH remained closed at 6 months after surgery with improved vision of 20 / 80.
The macular hole closed after intraoperative OCT-guided vitrectomy, ILM peeling and SF6 gas tamponade surgery. The critical steps that determine the surgical end-points for revisional macular hole surgery were easily visualized using intraoperative OCT. The ILM tissue landmarks and macular hole dimensions were evaluated using intraoperative OCT to allow successful surgery.