How Precise can the Status of the Posterior Vitreous be Examined prior to Vitrectomy by Biomicroscopy and Optical Coherence Tomography?
Hörri A., Richter D., Meyer C. H.
Centre of Ophthalmology, Philipps University, Marburg
Purpose: The stage of macular holes (MH) are classified by their size and associated status of the vitreous according to Gass. Usually the diagnosis is made by slitlamp examination.
Method: In a retrospective study we classified the MH in 18 consecutive patients (18 eyes) biomicroscopically with a 78-diopter-lens. Preoperative we performed 6 radial optical coherence tomography (OCT) scans and determined intraoperatively during a pars-plana vitrectomy (ppV) the presence of a posterior vitreous detachment (PVD).
Results: Biomicroscopically we determined a MH II (n=4), MH III (n=9) and MH IV (n=5). OCT demonstrated MH II (n=2), MH III (n=8) and MH IV (n=8). During a ppV we found a PVD (n=10) and no PVD (n=8). The results were similar in 9 cases (50%) between biomicroscopy and OCT, in 6 cases between biomicroscopy and ppV (33%), as well as in 16 cases (89%) between OCT and ppV.
Conclusions: Radial OCT-Scans can define fine preretinal adhesions of the vitreous and predic the status of the vitreous preoperatively. A precise classification gives important prognostic information about the MH. A preoperative determination of vitreoretinal adhesions gives the surgeon important information to plan surgery.
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