The role of intraoperative OCT in the management of stage 2 macular holes

Author: Georgios Batsos (Greece)

Co-authors: Efstratios Parikakis, Loukas Kontomichos, Theodora Gianni, Evita Evangelia Christou, Spyridon Atzamoglou, Vasileios Peponis

Purpose

To present a case of full thickness macular hole (FTMH) with concurrent vitreomacular adhesion (VMA), which was successfully treated with pars plana vitrectomy (PPV) assisted by an intraoperative OCT (iOCT).

Setting/Venue

Ophthalmiatreio Eye Hospital of Athens, 2nd Department of Ophthalmology, Retina Department.

Methods

A 68-year-old female presented with symptoms of blurred vision and metamorphopsia in her left eye. In this eye, the best corrected visual acuity was 20/200. The OCT examination revealed the presence of a full thickness macular hole with concurrent VMA. PPV was performed in this eye, using Leica Proveo 8 microscope integrated with iOCT. During the operation after the removal of VMA, the enlargement of the macular hole was confirmed by the iOCT. For this reason, the surgeon decided to extend the internal limiting membrane (ILM) peel to more than 1 disc diameter radius from the fovea. SF6 20% was used as a tamponade agent. Furthermore, the patient was advised to maintain a face down posture for five days.

Results

At the follow up, macular hole closure was confirmed by the OCT. The visual acuity was improved to 20/50 and metamorphopsia was absent.

Conlusions

iOCT can provide a real time assessment of the macular area. In cases of FTMH with concurrent VMA, the surgeon can confirm alterations in the macular area during the operation and can select other treatment options if needed. Thus, a more personalized approach can be achieved providing better anatomical and functional results.

Financial Disclosure

none