INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY DURING VITREORETINAL SURGERY FOR DENSE VITREOUS HEMORRHAGE IN THE PIONEER STUDY.

Abstract

To evaluate the feasibility and utility of intraoperative optical coherence tomography (OCT) during pars plana vitrectomy surgery for dense vitreous hemorrhage. The Prospective Assessment of Intraoperative and Perioperative OCT for Ophthalmic Surgery study examined the utility of intraoperative OCT in ophthalmic surgery. Intraoperative scanning was performed with a microscope-mounted spectral domain OCT system. This report is a case series of those eyes undergoing pars plana vitrectomy for dense central vitreous hemorrhage that precluded preoperative OCT assessment. Intraoperative OCT images were qualitatively evaluated for retinal abnormalities that might impact intraoperative or perioperative management. Clinical variables were collected and assessed. Surgeon assessment of intraoperative OCT utility was also evaluated. Twenty-three eyes were identified and included. The etiology for the vitreous hemorrhage was proliferative diabetic retinopathy (19 eyes, 82.6%), horseshoe retinal tear (1 eye, 4.3%), retinal vein occlusion with neovascularization (1 eye, 4.3%), presumed polypoid choroidal vasculopathy (1 eye, 4.3%), and presumed retinal arterial macroaneurysm (1 eye, 4.3%). Intraoperative OCT revealed epiretinal membrane (14 eyes, 60.9%), macular edema (14 eyes, 60.9%), posterior hyaloid traction (1 eye, 4.3%), and retinal detachment (1 eye, 4.3%). Surgeon feedback suggested that intraoperative OCT impacted surgical decision making in eyes where membrane peeling was performed. Intraoperative OCT during pars plana vitrectomy for vitreous hemorrhage may provide physicians with clinically relevant information that may impact surgical management, perioperative management, and patient outcomes.