IOCT-assisted macular hole surgery: Outcomes and utility from the DISCOVER study

Philina Yee, Duriye Damla Sevgi, Joseph Abraham, Sunil K. Srivastava, Thuy Le, Atsuro Uchida, Natalia Figueiredo, Aleksandra V. Rachitskaya, Sumit Sharma, Jamie Reese, Justis P. Ehlers

Research output: Contribution to journalArticle

Abstract

Background/aims: This study aimed to characterise the clinical outcomes and utility of intraoperative optical coherence tomography (iOCT)-assisted macular hole (MH) repair. Methods: This was a post hoc analysis of eyes in the Determination of feasibility of Intraoperative Spectral domain microscope Combined/integrated OCT Visualization during En face Retinal and ophthalmic surgery (DISCOVER) study undergoing surgical MH repair with use of iOCT. Functional and surgical outcome data were collected through 12 months postoperatively. MH closure rate, postoperative visual acuity (VA), percentage of cases in which iOCT provided valuable feedback and altered surgical decision making were measured. Results: Eighty-four eyes were included in this study. The mean preoperative VA measured 20/114. The mean postoperative VA improved to 20/68 (p<0.001) at month 1, 20/48 (p<0.001) at month 3 and 20/45 (p<0.001) at month 12 or later. In 43 cases (51%), surgeons reported that iOCT provided valuable information (eg, confirming release of vitreomacular traction and identification of occult residual membranes). In 10 cases (12%), iOCT data specifically altered surgical decision making. Postoperative day 1 transtamponade OCT confirmed tissue apposition and apparent hole closure in 74% of eyes (21/26). All five open holes on postoperative day 1 closed following positioning. Single-surgery MH closure was achieved in 97.6% of cases. One persistent MH was successfully closed with a subsequent surgical repair for a final overall closure rate of 98.8%. Due to chronicity and MH size, additional repair was not recommended for the single remaining persistent MH. Conclusion: This study suggests that iOCT may have important utility in MH surgery, including impacting surgical decision making. iOCT-assisted MH surgery resulted in significant improvement in VA and high single-surgery success rate.

Original languageEnglish
Article numberbjophthalmol-2020-316045
JournalBritish Journal of Ophthalmology
DOIs
Publication statusAccepted/In press - 2020 Jan 1
Externally publishedYes

Keywords

  • imaging
  • macula
  • treatment surgery

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

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