**Surgical Retina**

**Chapter 4**

**Provisional chapter**

**iOCT in PVR Surgical Management**

**iOCT in PVR Surgical Management**

DOI: 10.5772/intechopen.78774

Recent advances in optical coherence tomography (OCT) technology have allowed the introduction of OCT into the operating room. Intraoperative OCT (iOCT) has been utilized to visualize the retinal architecture prior, during, and following several retinal surgical technics. The identification of epiretinal, subretinal, and intraretinal changes is one of the crucial points in PVR management. The iOCT can identify intraretinal changes and/ or subretinal PVR membranes which cannot be easily peeled as epiretinal membranes. Intraretinal forms are especially difficult to identify preoperatively but their presence may be crucial in surgical management because the attempt to remove the presumed membrane may result in severe retinal tissue damage and iatrogenic tears. Therefore, surgical technique and even tamponade choice may be seriously affected by OCT imaging results.

**Keywords:** OCT, intraoperative OCT, PVR, retinal detachment, vitreo-retinal surgery

Optical coherence tomography (OCT) has dramatically changed the diagnosis, classification, and treatment of many vitreo-retinal diseases [1–3]. One of the most recent developments of this technology is the intraoperative OCT (iOCT). The iOCT allows a real-time tomographic visualization of the retina without the need to stop the surgery and without any external machines (microscope-integrated OCT). In this way, the surgeon can see OCT images during

iOCT adds microscopic information and visualizes sub-surface structures in a non invasive way. This information can impact surgical decision-making as well as surgical maneuvers in selected cases. In this sense, the intraoperative visualization of the retina opens new surgical

the surgery on an external display or directly through the microscope.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Salvatore Di Lauro, Salvador Pastor Idoate and

Salvatore Di Lauro, Salvador Pastor Idoate and

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.78774

Jose Carlos Pastor

Jose Carlos Pastor

**Abstract**

**1. Introduction**

#### **iOCT in PVR Surgical Management iOCT in PVR Surgical Management**

Salvatore Di Lauro, Salvador Pastor Idoate and Jose Carlos Pastor Salvatore Di Lauro, Salvador Pastor Idoate and Jose Carlos Pastor

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.78774

#### **Abstract**

Recent advances in optical coherence tomography (OCT) technology have allowed the introduction of OCT into the operating room. Intraoperative OCT (iOCT) has been utilized to visualize the retinal architecture prior, during, and following several retinal surgical technics. The identification of epiretinal, subretinal, and intraretinal changes is one of the crucial points in PVR management. The iOCT can identify intraretinal changes and/ or subretinal PVR membranes which cannot be easily peeled as epiretinal membranes. Intraretinal forms are especially difficult to identify preoperatively but their presence may be crucial in surgical management because the attempt to remove the presumed membrane may result in severe retinal tissue damage and iatrogenic tears. Therefore, surgical technique and even tamponade choice may be seriously affected by OCT imaging results.

DOI: 10.5772/intechopen.78774

**Keywords:** OCT, intraoperative OCT, PVR, retinal detachment, vitreo-retinal surgery

#### **1. Introduction**

Optical coherence tomography (OCT) has dramatically changed the diagnosis, classification, and treatment of many vitreo-retinal diseases [1–3]. One of the most recent developments of this technology is the intraoperative OCT (iOCT). The iOCT allows a real-time tomographic visualization of the retina without the need to stop the surgery and without any external machines (microscope-integrated OCT). In this way, the surgeon can see OCT images during the surgery on an external display or directly through the microscope.

iOCT adds microscopic information and visualizes sub-surface structures in a non invasive way. This information can impact surgical decision-making as well as surgical maneuvers in selected cases. In this sense, the intraoperative visualization of the retina opens new surgical

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

and diagnostic possibilities. Vitreo-retinal interphase diseases may especially benefit from iOCT spreading but also retinal detachment (RD) surgery could be positively affected.

Proliferative vitreoretinopathy (PVR) is one of the most severe complications after RD, appearing in 5–10% of them [4]. Despite recent advances in vitreo-retinal surgery, PVR management is still an unsolved issue [4]. The introduction of the iOCT in surgical practice could be useful in improving the management of this important complication.
