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Epiretinal Membrane Surgery Using Intraoperative OCT-Guided Membrane Removal in the DISCOVER Study versus Conventional Membrane Removal

  • Tisileli S. Tuifua
    Affiliations
    The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio

    Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
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  • Arjun B. Sood
    Affiliations
    The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio

    Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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  • Joseph R. Abraham
    Affiliations
    The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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  • Sunil K. Srivastava
    Affiliations
    The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio

    Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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  • Peter K. Kaiser
    Affiliations
    The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio

    Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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  • Sumit Sharma
    Affiliations
    The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio

    Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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  • Aleksandra Rachitskaya
    Affiliations
    The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio

    Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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  • Rishi P. Singh
    Affiliations
    The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio

    Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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  • Jamie Reese
    Affiliations
    The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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  • Justis P. Ehlers
    Correspondence
    Correspondence: Justis P. Ehlers, MD, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave/i32, Cleveland, OH 44106.
    Affiliations
    The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio

    Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
    Search for articles by this author
Published:February 26, 2021DOI:https://doi.org/10.1016/j.oret.2021.02.013

      Purpose

      To provide a comparative assessment of clinical outcomes between patients undergoing intraoperative OCT (iOCT) and conventional surgery for pars plana vitrectomy (PPV) with epiretinal membrane (ERM) peel.

      Design

      Case-control retrospective, comparative assessment.

      Participants

      Patients undergoing PPV with membrane peel for ERM with eyes pooled from the prospective Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery (DISCOVER) iOCT study and eyes undergoing conventional ERM surgery without iOCT.

      Methods

      Visual acuity and OCT assessment before ERM surgery and at 1-, 3-, 6-, and 12-month follow-up after standard small-gauge PPV with iOCT feedback (iOCT DISCOVER group) or PPV with compulsory internal limiting membrane (ILM) peeling (conventional group). Visual acuity, central subfield thickness (CST), reoperation rate, and ERM recurrence were determined by record review and post hoc assessment of clinical OCTs after ERM peel.

      Main Outcome Measures

      Visual acuity and ERM recurrence.

      Results

      A total of 262 eyes were included. Visual acuity (VA) improved 11.9 letters in the iOCT group (P < 0.0001) and 12.1 letters in the conventional group (P < 0.0001) at 12 months after ERM surgery. Visual acuity improvement did not differ between the iOCT and conventional groups at 1, 3, 6, or 12 months after surgery (P > 0.05 for each time point). Preoperative mean CST decreased in the iOCT group (P < 0.0001) and conventional group (P < 0.0001) with no difference between groups in CST reduction at 12 months (P = 0.36). No reoperations or visually significant recurrent ERMs occurred in either cohort.

      Conclusions

      Intraoperative OCT-guided ERM removal without mandated ILM peeling provided similar VA and anatomic results to conventional ILM peeling for ERM. Future randomized prospective studies are needed to assess fully the possible role of iOCT in ERM surgery and to evaluate the potential impact of nonfoveal ERM persistence or recurrence in comparison with conventional surgery.

      Keywords

      Abbreviations and Acronyms:

      AMD (age-related macular degeneration), CST (central subfield thickness), DONFL (dissociated optic nerve fiber layer), DDMS (diamond-dusted membrane scraper), DISCOVER (Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery), ETDRS (Early Treatment Diabetic Retinopathy Study), ERM (epiretinal membrane), ICG (indocyanine green), ILM (internal limiting membrane), IOCT (Intraoperative OCT), LogMAR (Logarithm of the minimum angle of resolution), PPV (pars plana vitrectomy), PIONEER (Prospective Intraoperative and Perioperative Ophthalmic Imaging With Optical Coherence Tomography), SD (standard deviation), SEM (standard error of the mean), VA (visual acuity)
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