Purpose: To evaluate the feasibility and utility of intraoperative optical coherence tomography (iOCT) during pars plana vitrectomy (PPV) surgery for dense vitreous hemorrhage (VH).
Methods: A retrospective, consecutive, interventional case series. A total of 68 dense VH patients (71 eyes) were enrolled, and the patients were divided into two groups. The control group (43 eyes) did not receive iOCT and the experimental group (28 eyes) did. All patients with macular structures that could not be assessed by preoperative OCT underwent PPV for dense VH. iOCT images were qualitatively evaluated for retinal abnormalities that might affect intraoperative management. The assessment of iOCT utility was evaluated by the surgeon. Intraoperative membrane peeling, postoperative macular structure, and postoperative visual acuity were compared between the two groups.
Results: There were no significant differences in sex, age, different etiologies of VH, or best corrected visual acuity between the two groups at baseline. In the experimental group, iOCT revealed macular edema (eight eyes, 28.6%), epiretinal membranes (ERM, five eyes, 17.9%), macular atrophy (one eye, 3.6%), lamellar macular hole (one eye, 3.6%), polypoidal choroidal vasculopathy (one eye, 3.6%), and the existence of both macular edema with ERM (one eye, 3.6%). Eight cases showed macular abnormalities on the iOCT images that were inconsistent with the surgeon's judgment without iOCT. iOCT imaging affected the surgical plan for seven of the eight cases. Significantly more iOCT eyes had intraoperative membrane peeling than control eyes (P = 0.01), while significantly fewer iOCT eyes had postoperative ERMs (P = 0.04).
Conclusions: iOCT during PPV for VH may provide the surgeon with clinically relevant information that influences surgical management. The iOCT group had a higher incidence of ERM peeling intraoperatively and lower incidence of ERM postoperatively compared with the control group.
Keywords: Intraoperative optical coherence tomography; best corrected visual acuity; pars plana vitrectomy; surgical management; vitreous hemorrhage.