Title

OPTIMIZING VISUALIZATION OF INTERNAL LIMITING MEMBRANE AND EPIRETINAL MEMBRANE IN MACULAR SURGERY WITH HEADS-UP DISPLAY.

Introduction

When the vision is affected by ERM, pars plana vitrectomy is recommended. Two platforms can be utilized for posterior pole visualization during surgery: traditional microscope (TM) and 3D heads-up display (3DM).An advantage 3DM is the ability to intraoperatively modify the digital image to improve the visualization of specific structures, such as ERM/ILM.

Methods

This observational, survey-based study analyzed 11 unique optical parameter profiles (OPP), in order to identify which provided better visualization of the ERM and ILM during EDM pars plana vitrectomy for epiretinal membrane.Fourteen graders analyzed each recorded video and completed a questionnaire comparing each of the 11 OPPs against the control image, using a likert scale, and each profile was graded from 1-7 (1 being the worst and 7 the best).

Results

Before ICG dye, increase of hue and contrast received highest grade average and after ICG dye, the increase of hue and saturation received the highest grade average.There were significant differences between grades considered better (grade of 5 or greater) and grades considered worse (grade of 4 or less) before and after ICG dye.Before the ICG dye, the parameter associated with better ERM visualization was an increase of hue (76% with grades 5,6, or 7) and after the application of ICG dye, the OPPs with increase of hue received 62% grades of 5 or greater.Most of the graders agreed that OPP could improve the visualization of the ERM before dye application but could not replace the ICG dye. However,they agreed that color filter could enhance ICG dye visualization of ILM membrane and 93% would utilize at least one of these filters for their surgeries.

Discussion

Our study indicated an overall positive impression of the OPP.The potential advantages of the digital platform in the context of retinal surgery are vast. Investigation into the platforms full potential is still in its early stages, but studies such as this will be instrumental in driving forward the use of this technology.

Keywords

3D heads-up vitrectomy; macular surgery; optical parameters profile

Area

SURGICAL CASE

Authors

Alline Gonçalves dos Reis Melo, Thais L Conti, Tyler F Greenlee, Grant L Hom, Rishi P Singh