Intrasurgical dynamics of macular hole surgery an assessment of surgery induced ultrastructural alterations with intraoperative optical coherence tomography英文电子书.pdfVIP

INTRASURGICAL DYNAMICS OF MACULAR HOLE SURGERY An Assessment of Surgery-Induced Ultrastructural Alterations with Intraoperative Optical Coherence Tomography JUSTIS P. EHLERS, MD, DAVID XU, BS, PETER K. KAISER, MD, RISHI P. SINGH, MD, SUNIL K. SRIVASTAVA, MD Purpose: To evaluate the intrasurgical retinal architectural and macular hole (MH) geometric alterations that occur during surgical MH repair using intraoperative optical coherence tomography. Methods: A retrospective, multisurgeon, single-center, consecutive case series of 21 eyes undergoing surgical repair for MH with concurrent intraoperative optical coherence tomography using a custom microscope–mounted optical coherence tomography system was performed. All patients underwent surgical repair with pars plana vitrectomy, mem- brane peel, and gas tamponade. A novel three-dimensional segmentation algorithm was used for volumetric analysis of intrasurgical changes of MH geometry after surgical repair. Intraoperative optical coherence tomographic characteristics analyzed included MH volume, minimum diameter, base area, and hole height. Outer retinal architecture changes were analyzed both quantitatively and qualitatively. Results: All 21 eyes were successfully imaged with intraoperative optical coherence tomography. Nineteen of 21 eyes had images of sufficient signal strength to allow for quantitative analysis. Significant changes were noted in MH geometry after internal limiting membrane peeling including increased MH volume, increased base area, and decreased top area (all P , 0.03). Additionally, increased subr