How Intrasurgical OCT can Impact the Surgical Approach to Membrane Peeling

May 04, 2017

When treating patients with vitreomacular traction (VMT), peeling of the inner limiting membrane (ILM) or an epiretinal membrane (ERM) is often indicated. Successful outcomes depend on precise surgical maneuvers as well as the surgeon’s experience in order to assess whether the entire membrane has been removed, as this is crucial for successful release of traction.

Having as much visual information as possible helps the surgeon confidently perform membrane peeling. It also supports identification of residual membranes, and examination of the retinal morphology immediately following the procedure for complications such as macular holes, sub-retinal edema or residual traction.

High-resolution cross-sectional imaging provided by intrasurgical optical coherence tomography (OCT) can provide vital anatomic information to surgeons during retinal procedures, helping to guide surgical decision-making.

Showing different steps of removing an ERM to resolve VMT, the following videos captured with EnFocus intrasurgical OCT demonstrate how visualization of the membrane can impact the surgical process of membrane peeling.

Case study 2

In this case from the University of Chicago, an epiretinal membrane was causing a traction retinal detachment. The videos show the benefits of intrasurgical OCT visualization at each stage of an ERM peel, from pre-operative scan to post-operative evaluation of full membrane removal.

Pre-operative scan

Pre-operative scan reveals the extent of the large epiretinal membrane causing a traction retinal detachment.

First stage of ERM peel

The forcep pushing on the retina is clearly seen during membrane peeling.

Cutting of the membrane

Real-time visualization supports surgical precision during membrane cutting.

Laser surgery post ERM peel

Laser surgery post membrane peel shows plumes emitted from the retina.

Volume scan helps confirm completion

Final volume scan of the retina determines if there is any residual membrane and helps confirm the surgical endpoint has been reached.

Case study 1

Watch these videos to see how imaging with EnFocus intrasurgical OCT supported identification of an epiretinal membrane (ERM) causing vitreomacular traction (VMT) and helped guide intrasurgical decision-making.

Vitreomacular traction (VMT) and Epiretinal membrane (ERM)

Pre-operative retinal scan shows vitreomacular traction (VMT) and Epiretinal membrane (ERM)

OCT reveals residual membrane

After ERM peeling, OCT reveals residual membrane creating longitudinal traction.

OCT confirms that the membrane creating longitudinal traction has been severed

After further surgical intervention, OCT confirms that the membrane creating longitudinal traction has been severed and no macular hole created. The surgeon decides air exchange is not required, sparing the patient from prone positioning.

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