ZEISS OPMI LUMERA 700

with intraoperative OCT

Welcome to the ZEISS OPMI LUMERA® 700 with intraoperative OCT Virtual Case Library

  • Anterior
    Central corneal scarring of the left eye before surgery

    Fig. 1 Slit lamp and OCT images showing central corneal scarring of the left eye before surgery

    Visco-Bubble assisted DALK for Deep Central Stromal Scarring

    Authors: Matthias Fuest, MD; Jodhbir S Mehta, MD, Singapore
    central corneal scarring of the left eye one year after visco-bubble DALK surgery

    Fig. 2 Slit lamp and OCT images showing central corneal scarring of the left eye one year after visco-bubble DALK surgery

    intraoperative OCT showed corneal scarring

    Fig. 3 After initial debulking of 50 % of the corneal stroma, intraoperative OCT showed corneal scarring did not extensively involve as much of the Descemet Membrane as originally thought

    Descemet Membrane separation succeeded by viscoelastic injection

    Fig. 4 Descemet Membrane separation succeeded by viscoelastic injection

    Manual separation of residual adherent stroma from Descemet Membrane

    Fig. 5 Manual separation of residual adherent stroma from Descemet Membrane

    Manual separation of residual adherent stroma from Descemet Membrane

    Fig. 6 Manual separation of residual adherent stroma from Descemet Membrane

    Patient history A 70-year-old female patient presented with deep central stromal scarring in the left eye thought to be due to interstitial keratitis (Fig. 1).
    Planned treatment without intraoperative OCT Because of the suspected extension of the corneal scar to the Descemet Membrane the patient was initially planned for a deep manual DALK.
    Treatment with intraoperative OCT

    Starting with a manual debulking of the cornea to 50 % of stromal thickness, intraoperative OCT revealed that the scar did not involve as much of the Descemet Membrane as originally thought and was not as extensive as seen on OCT preoperatively (Fig. 1 – 3).

    Forceful air injection in order to obtain a big-bubble was attempted twice but failed to cause a detachment of the Descemet Membrane due to adhesions between the scar and posterior stroma / Descemet Membrane complex. However, a separation was then achieved by slow injection of viscoelastic while visualising with intraoperative OCT (Fig. 4). The overlying stroma was incised with a blade to release the viscoelastic and to allow subsequent safe stromectomy (Fig. 4). The residual adherent stroma could then be carefully separated by manual dissection down to Descemet Membrane especially in the adherent areas (Fig. 5 and 6).

    Intraoperative OCT allowed the surgeon to vary the tension on the remaining stroma to hold it taut with forceps to allow dissection of the remaining stromal fibres but not to elevate the Descemet Membrane and risk a Descemet Membrane perforation (Fig. 6).

    Conclusion Intraoperative OCT enabled the simultaneous visualisation and analysis in this challenging case of anterior lamellar keratoplasty. It allowed a safe dissection down to Descemet Membrane, instead of a manual pre-Descemet Membrane DALK or penetrating keratoplasty. One year post-op the patient has a clear corneal graft, is not taking any topical medication and is awaiting cataract surgery.
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    Face-down graft postion easily verified with the intraoperative OCT

    Face-down graft postion easily verified with the intraoperative OCT

    Face-down graft postion easily verified with the intraoperative OCT

    Difficult DMEK: An unexpected challenging DMEK surgery, due to the orientation of the graft

    Marta Calatayud, MD, Spain
    Recurrent erroneous orientation of the graft. The corneal stroma is edematous and the blue staining is not optimal. Observe the difference between the microscope images by comparing the previous image, which gets worse with time, as the intraoperative OCT is very clear

    Recurrent erroneous orientation of the graft. The corneal stroma is edematous and the blue staining is not optimal. Observe the difference between the microscope images by comparing the previous image, which gets worse with time, as the intraoperative OCT is very clear

    Recurrent erroneous orientation of the graft. The corneal stroma is edematous and the blue staining is not optimal. Observe the difference between the microscope images by comparing the previous image, which gets worse with time, as the intraoperative OCT is very clear
    The graft is partially unfolded, but still face-down

    The graft is partially unfolded, but still face-down

    The graft is partially unfolded, but still face-down
    The partially unfolded graft is mobilized and can controlled during every moment of the situation and reorientation. Note how the corneal transparency decreases while the intraoperative OCT image is clear

    The partially unfolded graft is mobilized and can controlled during every moment of the situation and reorientation. Note how the corneal transparency decreases while the intraoperative OCT image is clear

    The partially unfolded graft is mobilized and can controlled during every moment of the situation and reorientation. Note how the corneal transparency decreases while the intraoperative OCT image is clear
    The only way to confirm the graft is in the correct position is with intraoperative OCT

    The only way to confirm the graft is in the correct position is with intraoperative OCT

    The only way to confirm the graft is in the correct position is with intraoperative OCT
    Patient history A 68-year-old female with bilateral Fuch’s distrophy, pseudophakic and with best corrected visual acuity of 20 / 200.
    Planned treatment without intraoperative OCT

    Preoperative anterior segment examination was normal, so patient was scheduled for a regular DMEK. After descemethorexis the graft, previously prepared in the operating room, was inserted into the anterior chamber. The first problem we observed was the graft was upside down. We injected fluid and tried to reverse the orientation but it unfolded as a “taco”.

    As time passed, the cornea became more edematous and the graft lost the blue staining. This is an additional problem for the surgeon – we do not know how the graft is positioned.

    At the moment you loose your graft, without intraoperative OCT RESCAN 700, you need to make a choice: abandon and delay surgery or change to penetrating keratoplasty versus DSAEK, depending on the corneal edema,
    if you have the tissue.

    Treatment with intraoperative OCT In this case, intraoperative OCT was essential to finish the surgery as it was planned initially. The only solution is to find a method to bypass the corneal edema and “enter” into the anterior chamber to “see” the graft: intraoperative OCT.
    Conclusion Intraoperative OCT allows the surgeon to locate and orientate the graft
    until it is in the correct position, avoiding excessive manipulation. It´s very helpful in difficult cases and those cases that, for several reasons, become complicated during the procedure. Intraoperative OCT is an important tool that improves corneal lamellar surgery.

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    Surgical view: Despite trypan blue stain of the DMEK roll, the Descemet’s membrane is invisible through the surgical microscope. However, intraoperative OCT allows visualization of the graft and also supports confirmation of its correct orientation

    Surgical view: Despite trypan blue stain of the DMEK roll, the Descemet’s membrane is invisible through the surgical microscope. However, intraoperative OCT allows visualization of the graft and also supports confirmation of its correct orientation

    Surgical view: Despite trypan blue stain of the DMEK roll, the Descemet’s membrane is invisible through the surgical microscope. However, intraoperative OCT allows visualization of the graft and also supports confirmation of its correct orientation

    OCT-assisted Descemet Membrane Endothelial Keratoplasty (DMEK) for the management of severe post-herpetic corneal decompensation

    Eric E. Gabison, MD, France
    One Month following surgery, slit lamp
examination shows improved corneal transparency with iris clearly visible and as well as the edge of the DMEK graft at its superior part

    One Month following surgery, slit lamp examination shows improved corneal transparency with iris clearly visible and as well as the edge of the DMEK graft at its superior part

    One Month following surgery, slit lamp
examination shows improved corneal transparency with iris clearly visible and as well as the edge of the DMEK graft at its superior part
    Patient history A 70-year-old patient with a past history of severe corneal endothelitiswas referred to the corneal department for chronic corneal edemaassociated with stromal fibrosis. Visual acuity was limited to hand motion.Corneal anesthesia was noted.
    Planned treatment without intraoperative OCT
    Planned treatment without OCT could have been Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) as penetrating keratoplastyis of poor prognosis due to corneal anesthesia. Aggressive corneal surgerybears the risk of impaired healing and corneal melt. While in this situation DMEK could have been favored due to the smaller size of the incision, the visibility though the edematous and fibrotic cornea may only allow the DSAEK procedure.
    Treatment with intraoperative OCT Although the corneal transparency was lost, a DMEK procedure was chosen.The perioperative intraoperative OCT RESCAN 700 allowed the anterior chamber visibility and the DMEK roll proper orientation. The procedure was successfully performed under complete intraoperative OCT guidance.
    Conclusion The surgery was made possible by the use of intraoperative OCT.Intraoperative OCT allowed the visualization, the proper orientation and the unrolling of the DMEK roll while performing the procedure. Visual acuity 1 month following surgery was 20 / 40. Antiviral treatment and corticosteroid were given before and following the surgery.
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    Pre op: Severe Corneal decompensation, Corneal Edema. VA: CF

    Pre op: Severe Corneal decompensation, Corneal Edema. VA: CF

    Pre op: Severe Corneal decompensation, Corneal Edema. VA: CF

    DMEK in the presence of severe corneal edema

    Author: Alain Saad, France
    Post-op, VA: 20 / 80

    Post-op, VA: 20 / 80

    Post-op, VA: 20 / 80
    Intra op: Visualization of
the graft orientation (Inverted here, as the graft edges are rolling toward the anterior chamber) using the intraoperative OCT despite
the severe corneal edema

    Intra op: Visualization of the graft orientation (Inverted here, as the graft edges are rolling toward the anterior chamber) using the intraoperative OCT despite the severe corneal edema

    Intra op: Visualization of
the graft orientation (Inverted here, as the graft edges are rolling toward the anterior chamber) using the intraoperative OCT despite
the severe corneal edema
    Intra op: Rotation of the graft and confirmation of the correct orientation using the intraoperative
OCT: Edge of the graft rolling up toward the posterior stroma

    Intra op: Rotation of the graft and confirmation of the correct orientation using the intraoperative OCT: Edge of the graft rolling up toward the posterior stroma

    Intra op: Rotation of the graft and confirmation of the correct orientation using the intraoperative
OCT: Edge of the graft rolling up toward the posterior stroma
    Patient history Severe endothelial decompensation 5 years after myopic anterior chamber IOL implantation leading to a severe corneal edema in this 32-year-old woman.
    Planned treatment without intraoperative OCT DSAEK would have been performed in the absence of the intraoperative OCT as it was very difficult to visualize the AC.
    Treatment with intraoperative OCT

    DMEK was performed. Despite the severe corneal edema, the intraoperative OCT helped evaluating the graft orientation and positioning.

    The endothelial roll was first in the wrong orientation and the intraoperative OCT allowed to visualize and detect it. The roll was turned and the intraoperative OCT confirmed its correct orientation.

    Conclusion Intraoperative OCT permits DMEK surgery even in severe corneal edema. Graft orientation could be assessed.
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    Before surgery

    Before surgery

    Before surgery

    Cataract surgery in patient with corneal opacities

    Author: Edward Wylegala, Poland
    One day surgery

    One day surgery

    One day surgery
    Follow-up 6 month after surgery BCVA 0.1

    Follow-up 6 month after surgery BCVA 0.1

    Follow-up 6 month after surgery BCVA 0.1
    Corneal thinning

    Corneal thinning

    Corneal thinning
    IOL

    IOL

    IOL
    Patient history A 38-year-old female suffering from neurotrophic keratitis. VA RE – no light perception VA LE – light perception. RE optic nerv atrophyLE – corneal central ulcer with white cataract.
    Planned treatment without intraoperative OCT

    The patient had not been subjected to the combined surgery of penetrating keratoplasty with cataract extraction – poor graft survival expected. Slit-lamp assistance, transcorneal illumination and endoscopy assistance for anterior eye segment visualization.

    How to remove cataract safely without good visualization?

    Treatment with intraoperative OCT

    Phacoemulsification surgery with IOL implantaion using realtime intraoperative OCT RESCAN 700 in patient with poor visibility of the lens.

    Conclusion

    Visualisation of capsule and localization of IOL after implantation LE BCVA after 6 month= 0.1

    Removing cataract and IOL implantation with realtime intraoperative OCT became possible and the patient had a safe and successful procedure.

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    Fig. 1 Some fluid in interface at 12 o’clock

    Fig. 1 Some fluid in interface at 12 o’clock

    Fig. 1 Some fluid in interface at 12 o’clock

    Re-DSAEK in functional monocular patient

    Authors: Isabelle EY Saelens, MD, PhD; Rudy MMA Nuijts, MD, PhD, The Netherlands
    Fig. 2 Draining the fluid through the venting incision

    Fig. 2 Draining the fluid through the venting incision

    Fig. 2 Draining the fluid through the venting incision
    Fig. 3 No fluid in interface after venting

    Fig. 3 No fluid in interface after venting

    Fig. 3 No fluid in interface after venting
    Fig. 4 Well attached DSAEK lamella after reducing the air bubble in the anterior chamber

    Fig. 4 Well attached DSAEK lamella after reducing the air bubble in the anterior chamber

    Fig. 4 Well attached DSAEK lamella after reducing the air bubble in the anterior chamber
    Patient history A 69-year-old woman with Fuchs endothelial dystrophy and narrow angle glaucoma. BCVA on her right eye was 20/50 (S+0,75, C1,0x55) and 1/60 on her left eye, due to deep amblyopia. In 2013, she had DSAEK surgery on her right eye. Because of decreasing BCVA due to some folds in the posterior lamella, a re-DSAEK was planned.
    Planned treatment without intraoperative OCT

    Precut Ultrathin re-DSAEK under local anesthesia

    • After removal of the previous DSAEK graft, you cannot check the recipients stromal side to check for stromal or donor remnants
    • At the end of surgery, you do not have confirmation about the attachment of the donor lamella. If the OCT image is performed outside the operating theater and shows a problem you would like to restore surgically, the patient must be brought back to the OR.
    Treatment with intraoperative OCT

    Precut Ultrathin re-DSAEK under local anesthesia

    • intraoperative OCT images before and after venting show that there is no air or fluid in the interface after the venting manoever. At the end of surgery, there is the confirmation that the donor lamel is well attached to the recipient or not.
    Conclusion

    With the intraoperative OCT, there is:

    • Inspection of the recipients stromal bed after Descemetorhexis
    • Confirmation on the attachment of the donor graft
    • Time-saving
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    Fig. 1 Intraoperative OCT shows how deep is the scleral flap and helps to prevent flap loss or premature entry into the anterior chamber

    Fig. 1 Intraoperative OCT shows how deep is the scleral flap and helps to prevent flap loss or premature entry into the anterior chamber

    Fig. 1 Intraoperative OCT shows how deep is the scleral flap and helps to prevent flap loss or premature entry into the anterior chamber

    Trabeculectomy

    Authors: Visanee Tantisevi, MD; Chiratthisuang Thitikulwanich, MD, Thailand
    Fig. 2 Intraoperative OCT shows sclerostomy, peripheral iridectomy sites and anterior chamber depth maintenance

    Fig. 2 Intraoperative OCT shows sclerostomy, peripheral iridectomy sites and anterior chamber depth maintenance

    Fig. 2 Intraoperative OCT shows sclerostomy, peripheral iridectomy sites and anterior chamber depth maintenance
    Fig. 3 and 4 Intraoperative OCT helps identify scleral approximation

    Fig. 3 and 4 Intraoperative OCT helps identify scleral approximation

    Fig. 3 and 4 Intraoperative OCT helps identify scleral approximation
    Fig. 4

    Fig. 4

    Fig. 4
    Patient history An 80-year-old female with advanced primary open angle glaucoma (POAG) with unsatisfactory intraocular pressure control with medication in the right eye. She is blind in the left eye.
    Planned treatment without intraoperative OCT

    Trabeculectomy with mitomicin C with precaution of unexpected sclera flap loss. Patient had clinically thin-looking sclera. Plan was to check for thickness of the scleral flap during the procedure.

    Treatment with intraoperative OCT

    Intraoperative OCT can provide sclera cross-section and assist the surgeon to determine how deep the flap can be (Fig. 1). In this case, the sclera was not as thin as it was initially observed. Moreover, intraoperative OCT visualized the sclerostomy, periphera iridectomy site as well as anterior chamber depth maintenance immediately after the procedure was completed (Fig. 2).

    Conclusion

    Cross-section image of the sclera shows the scleral flap actual depth. Intraoperative OCT can guide the surgeon on scleral thickness and assist the surgeon on anterior chamber depth maintenance after sclerostomy, which can be another guiding tool on filtering procedure in eyes with poorly visible anterior chamber depth, eg. Fig. 3 & 4, corneal graft edema and corneal scar, where intraocular pressure needs surgical control.

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    Fig. 1 A near total Descemet detachment was found after reforming a post-trabeculectomy hypotony eye with viscoelastic agent and BSS

    Fig. 1 A near total Descemet detachment was found after reforming a post-trabeculectomy hypotony eye with viscoelastic agent and BSS

    Fig. 1 A near total Descemet detachment was found after reforming a post-trabeculectomy hypotony eye with viscoelastic agent and BSS

    Descemet Membrane detachment

    Authors: lavun Puangsricharern, MD; Anita Manassakorn, MD; Prin Rojanapongpun, MD, Thailand
    Fig. 2 Descemet detachment at the center of the cornea extends to near the limbus. A small intact Descemet is identified at the far periphery of inferior cornea

    Fig. 2 Descemet detachment at the center of the cornea extends to near the limbus. A small intact Descemet is identified at the far periphery of inferior cornea

    Fig. 2 Descemet detachment at the center of the cornea extends to near the limbus. A small intact Descemet is identified at the far periphery of inferior cornea
    Fig. 3 Intraoperative OCT, both vertical and horizontal line scans, clearly identifies a small area of intact Descemet. This helps guiding the best entry site for the needle as well as visually check the reattachment after injection of SF6 gas

    Fig. 3 Intraoperative OCT, both vertical and horizontal line scans, clearly identifies a small area of intact Descemet. This helps guiding the best entry site for the needle as well as visually check the reattachment after injection of SF6 gas

    Fig. 3 Intraoperative OCT, both vertical and horizontal line scans, clearly identifies a small area of intact Descemet. This helps guiding the best entry site for the needle as well as visually check the reattachment after injection of SF6 gas
    Fig. 4 With intraoperative OCT, live image guides the precise depth for the corneal suture onto the Descemet Membrane to firmly reattach the Descemet to the cornea

    Fig. 4 With intraoperative OCT, live image guides the precise depth for the corneal suture onto the Descemet Membrane to firmly reattach the Descemet to the cornea

    Fig. 4 With intraoperative OCT, live image guides the precise depth for the corneal suture onto the Descemet Membrane to firmly reattach the Descemet to the cornea
    Fig. 5 The attachment of Descemet Membrane after 20% SF6 injection into anterior chamber to remove viscoelastic from the false chamber through corneal incision

    Fig. 5 The attachment of Descemet Membrane after 20% SF6 injection into anterior chamber to remove viscoelastic from the false chamber through corneal incision

    Fig. 5 The attachment of Descemet Membrane after 20% SF6 injection into anterior chamber to remove viscoelastic from the false chamber through corneal incision
    Patient history A 70-year-old man presented with hypotony after trabeculectomy. The anterior chamber was reformed with viscoelastic and balanced salt solution. This led to a near total Descemet detachment (Fig. 1). The patient was brought back to reattach the Descemet Membrane.
    Planned treatment without intraoperative OCT Because of a nearly total Descemet detachment, a needle must only enter the anterior chamber through the remaining small area of intact Descemet Membrane
    (Fig. 2). If intracameral 20% SF6 is injected into the wrong location, it will further detach the Descemet Membrane and create a total detachment. Besides, it would be difficult to confirm the location and degree of attachment and the remaining space of any false chamber.
    Treatment with intraoperative OCT With intraoperative OCT, the needle entry site can be precisely identified and the tip of the needle can be visually checked before injecting SF6 (Fig. 3). In addition, the attachment of Descemet Membrane and reduction of false chamber after SF6 injection is clearly identified. Live imaging guides the precise depth for the corneal suture onto the Descemet Membrane to firmly reattach the Descemet to cornea (Fig. 4)
    Conclusion
    1. Clearly demonstrate the location of Descemet Membrane and anterior chamber, especially the enter site
    2. Monitor the attachment of Descemet Membrane and reduction of false chamber
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  • Posterior
    Intraoperative OCT image

    Fig. 1 Intraoperative OCT image after standard suturing, showing micro-gape that is a risk factor for postoperative wound leakage

    Assessment of scleral wound closure following Retisert implant exchange

    Author: Jay M. Stewart, MD, San Francisco
    Subsequent intraoperative OCT image

    Fig. 2 Subsequent intraoperative OCT image obtained after placement of extra-tight sutures and removal of original standard-tension sutures, demonstrating absence of any residual micro-gape

    Patient history A 25-year-old woman with chronic uveitis who had undergone Retisert implantation four years ago and now presented for device exchange.
    Planned treatment without intraoperative OCT Long-term steroid implantation and prior surgery have been associated with scleral thinning at the implant site. Adequacy of wound closure is generally assessed by visual inspection. In a number of cases, patients undergoing Retisert exchange have experienced self-limited postoperative hypotony, presumably due to microscopic wound leaks.
    Treatment with intraoperative OCT Intraoperative OCT was performed during and after wound suturing. It revealed that standard wound closure resulting in an apparently watertight wound actually had micro-gaps that were concerning for possible subsequent leakage and hypotony. Additional extra-tight suturing was performed, and intraoperative OCT showed resolution of the gaps. On postoperative day one, the patient‘s intraocular pressure was at her baseline.
    Conclusion Intraoperative OCT helped detect areas suspicious for microscopic wound gap that were not easily identified using standard visualization. By indicating the need for additional suturing, the information helped avoid postoperative hypotony and improved the patient‘s outcome.
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    Preoperative OCT image

    Preoperative OCT image

    Preoperative OCT image

    Lamellar macular hole identified by intraoperative OCT RESCAN 700

    Shunji Kusaka, MD, Japan
    Postoperative OCT image

    Postoperative OCT image

    Postoperative OCT image
    After membrane removal, the presence of lamellar macular hole could be identified only by intraoperative OCT, was not possible by observation through a surgical microscope

    After membrane removal, the presence of lamellar macular hole could be identified only by intraoperative OCT, was not possible by observation through a surgical microscope

    After membrane removal, the presence of lamellar macular hole could be identified only by intraoperative OCT, was not possible by observation through a surgical microscope
    Patient history A 45-year-old female with type 2 diabetes mellitus underwent phacovitrectomybecause of the vitreomacular traction and extramacular traction retinal detachment.
    Planned treatment without intraoperative OCT

    Phacovitrectomy with membrane peeling. If no retinal breaks were developed, no tamponade was planned.

    After the membrane peeling, the exact configuration of the macula (macular hole, lemellar macular hole, pseudo-macular hole, or normal) was difficult to assess by surgical microscope.

    Treatment with intraoperative OCT By checking the image of intraoperative OCT from ZEISS the diagnosis of a lamellar macular hole was supported and easily made. Then, the decision was made to peel the internal limiting membrane around the hole followed by air tamponde.
    Conclusion The presence of a lamellar macular hole was easily identified using intraoperative OCT. As a result, the lamellar macular hole was closed, which I believe is associated with better visual results. Visual acuity improvement from 0.2 (preop) to 0.6 (postop).

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    Upper OCT shows very large FTMH with 20 / 200 vision.
Lower OCT shows hole status after first surgery failed

    Upper OCT shows very large FTMH with 20 / 200 vision. Lower OCT shows hole status after first surgery failed

    Upper OCT shows very large FTMH with 20 / 200 vision.
Lower OCT shows hole status after first surgery failed

    Intraoperative OCT-guided closure in revisional macular hole surgery

    Mahi Muqit; PhD, United Kingdom
    The intraoperative OCT localizes the remnant of ILM
that can be seen protruding from the right side of the macular hole

    The intraoperative OCT localizes the remnant of ILM that can be seen protruding from the right side of the macular hole

    The intraoperative OCT localizes the remnant of ILM
that can be seen protruding from the right side of the macular hole
    The ILM is brushed off using diamond-dusted Tano
instrumentation, and the intraoperative OCT is able to visualize this ILM tissue dissection

    The ILM is brushed off using diamond-dusted Tano instrumentation, and the intraoperative OCT is able to visualize this ILM tissue dissection

    The ILM is brushed off using diamond-dusted Tano
instrumentation, and the intraoperative OCT is able to visualize this ILM tissue dissection
    After foveal detachment using BSS, the elevated macular hole edges are seen clearly on intraoperative OCT

    After foveal detachment using BSS, the elevated macular hole edges are seen clearly on intraoperative OCT

    After foveal detachment using BSS, the elevated macular hole edges are seen clearly on intraoperative OCT
    After air-fluid exchange, the elevated edges of the macular hole can be visualized with intraoperative OCT

    After air-fluid exchange, the elevated edges of the macular hole can be visualized with intraoperative OCT

    After air-fluid exchange, the elevated edges of the macular hole can be visualized with intraoperative OCT
    Patient history A 78-year-old female had failed phacovitrectomy, internal limiting membrane (ILM) peel with C3F8 gas surgery for a very large full-thickness macular hole (FTMH). She underwent revisional vitrectomy surgery for an open hole.
    Planned treatment without intraoperative OCT During 23-G vitrectomy surgery without OCT, there were no obvious signs of residual ILM identified using macular blue stain.
    Treatment with intraoperative OCT The intraoperative OCT RESCAN 700 was essential to assist in visualization of the remnants of ILM that were inducing persisting traction and keeping the macular hole open. A collar of residual ILM was located at the edge of the macular hole using intraoperative OCT guidance, and the ILM tissue was removed successfully with intraoperative OCT. The technique of localized foveal retinal detachment using balance salt solution was performed but the endpoint of raised macular hole edges was difficult to judge. The intraoperative OCT system supported accurate calculation of the size of foveal retinal detachment. The raised edges of the FTMH were significantly elevated at the end of surgery to maximize the chances of hole closure and the maximum diameter of the FTMH assessed. Based on the intraoperative size of the macular hole using intraoperative OCT, a short-acting gas bubble was used for the surgery. The FTMH remained closed at 6 months after surgery with improved vision of 20 / 80.
    Conclusion The macular hole closed after intraoperative OCT-guided vitrectomy, ILM peeling and SF6 gas tamponade surgery. The critical steps that determine the surgical end-points for revisional macular hole surgery were easily visualized using intraoperative OCT. The ILM tissue landmarks and macular hole dimensions were evaluated using intraoperative OCT to allow successful surgery.

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    Traumatic corneoscleral laceration sutured, with irido-dialysis, temporal iris loss, and traumatic cataract

    Traumatic corneoscleral laceration sutured, with irido-dialysis, temporal iris loss, and traumatic cataract

    Traumatic corneoscleral laceration sutured, with irido-dialysis, temporal iris loss, and traumatic cataract

    Traumatic retinal folds

    Rob Henderson, PhD, United Kingdom
    Spontaneously reattached retina with multiple retinal folds and sub-retinal haemorrhage

    Spontaneously reattached retina with multiple retinal folds and sub-retinal haemorrhage

    Spontaneously reattached retina with multiple retinal folds and sub-retinal haemorrhage
    Intraoperative OCT demonstrating attached retina and retinal fold

    Intraoperative OCT demonstrating attached retina and retinal fold

    Intraoperative OCT demonstrating attached retina and retinal fold
    Intraoperative OCT showing reasonably normal macular architecture

    Intraoperative OCT showing reasonably normal macular architecture

    Intraoperative OCT showing reasonably normal macular architecture
    Patient history

    A 7-year-old boy sustained a penetrating globe rupture to his left eye. Following primary repair he was referred and found to have temporal iris loss, a total cataract, and on ultrasound a total retinal detachment. Two weeks later, at surgery, and following a lensectomy, the retinal detachment had settled, but with multiple retinal folds extending up to the fovea, and an area of subretinal haemorrhage associated with a possible incarceration site temporally. A superior retinal tear with subretinal fluid tear was identified on indentation.

    The questions that needed resolving in order to determine the surgical plan were:

    1. Is the retina fully attached or is there shallow subretinal fluid, which we can use to restore more normal retinal anatomy? Should we re-detach the retina more fully with a sub-retinal injection of BSS?

    2. Do the folds involve the fovea – meaning that re-detaching retina is more desirable?

    Planned treatment without intraoperative OCT

    1. Possible shallow fluid present, but not enough to restore anatomy

    2. Folds very close to fovea

    3. Given trauma and haemorrhage, patient has a high likelihood of developing PVR making more extensive surgery less desirable

    Treatment with intraoperative OCT

    1. No subretinal fluid present

    2. Folds do not involve fovea and there is reasonable central macular architecture

    3. Do not re-detach retina, but instead secure with 360 laser barrage and tamponade superior detachment with 25 % SF6

    Conclusion ZEISS intraoperative OCT facilitated much improved intraoperative surgical planning and prevented an unnecessary and more extensive procedure.

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    Preoperative OCT image

    Preoperative OCT image

    Preoperative OCT image

    Vitreomacular traction syndrome

    Authors: Oliver Findl, MD; Christoph Leisser, MD, Austria
    Intraoperative OCT image

    Intraoperative OCT image

    Intraoperative OCT image
    Gas tamponade can be seen as gray shadow in the upper part of the image

    Gas tamponade can be seen as gray shadow in the upper part of the image

    Gas tamponade can be seen as gray shadow in the upper part of the image
    Patient history An 86-year-old female patient with vitreomacular traction syndrome.
    Planned treatment without intraoperative OCT Patient was scheduled for 23G pars plana vitrectomy with membrane peeling of left eye – challenging in that case was the small “bridge” of tissue under the epiretinal membrane, in danger of being damaged during peeling.
    Treatment with intraoperative OCT With the intraoperative OCT RESCAN 700, membrane peeling could be controlled at each phase of the procedure. Preoperative (Fig. 1), intraoperative (Fig. 2) and postoperative OCT scans (Fig. 3 – gas tamponade can be seen as gray shadow in the upper part of the image) are provided.
    Conclusion Intraoperative OCT provided anatomical information during all phases of the peeling procedure, therefore the epiretinal membrane could be gently removed. The small “bridge of tissue” over the tractive cysts in the fovea was not damaged during the peeling procedure and the intraretinal cysts started to reabsorb after surgery.
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