OSLI Retina

October 2020

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584 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ T E C H N I Q U E ■ Optimizing Visualization of Membranes in Macular Surgery With Heads-Up Display Alline G.R. Melo, MD; Thais F. Conti, MD; Grant L. Hom, BA; Tyler E. Greenlee, DO; Wener P. Cella, PhD; Katherine E. Talcott, MD; Aleksandra Rachitskaya, MD; Alex Yuan, PhD; Arjun Sood, MD; Ronald Milam, MD; Sruthi Arepalli, MD; Thomas Mendel, MD; Felipe P. Muralha, MD; Felipe Pereira, MD; Felipe F. Conti, MD; Marina R. Ciongoli, MD; Thaisa S. Barbosa, MD; Luciana L. Linhares, MD; Rishi P. Singh, MD BACKGROUND AND OBJECTIVE: To determine which optical parameter profiles (OPPs) can be utilized to improve the visualization of epiretinal membranes (ERMs) and the internal limiting membrane (ILM) using a three-dimensional heads-up microscope during 25-gauge pars plana vitrectomy. PATIENTS AND METHODS: Fourteen independent graders were asked to complete a questionnaire comparing each of the OPPs against the unaltered control image for each given surgical case. RESULTS: Analysis of the graders' responses indi- cated that higher values of hue are correlated with better visualization of ERM/ILM before and after dye application. There was overall agreement that OPPs could be used to enhance the visualization of the ERM and ILM during surgery. CONCLUSIONS: The use of OPPs to improve the vi- sualization of specific structures is still new and heavily dependent on surgeon preference. The au- thors' study shows that some OPPs may enhance the visualization of the ERM and ILM during macu- lar surgery. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:584-587.] INTRODUCTION Epiretinal membranes (ERMs) are fibrocellular proliferations that are often asymptomatic and idio- pathic. When the vision is affected, pars plana vit- rectomy (PPV) with peeling of the ERM is recom- mended. 1 Currently, two platforms can be utilized for posterior pole visualization during surgery: tradi- tional microscope (TM) and three-dimensional (3-D) heads-up display (3DM). 2 Several studies highlight the differences between these platforms, describing advantages of the 3DM. 3,4 One of these advantages is the ability to intraoperatively modify the digital image by manipulating parameters, which could improve ERM visualization and provide an alternative to the use of dyes that are commonly utilized to identify the ERM tissue. Unfortunately, there are no studies ana- lyzing these settings, only anecdotal experiences that depend substantially on each individual user. TECHNIQUE This observational, survey-based study evaluat- ed preferred parameters among surgeons from mul- tiple centers. Institutional review board approval was obtained to retrospectively evaluate videos of procedures from 10 eyes of 10 patients who were 18 years or older and underwent PPV for ERM be- tween May and August 2019. All surgical procedures were performed at Cole Eye Institute, Cleveland, Ohio by one surgeon (RPS) From Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio (AGRM, TFC, TEG, KET, AR, RPS); Cole Eye Institute, Cleve- land Clinic, Cleveland, Ohio (KET, AR, AY, AS, RM, SA, TM, RPS); Case Western Reserve University School of Medicine, Cleveland, Ohio (GLH, RPS); Reference Hospital in Ophthalmology,HRO, São Luis, Maranhão, Brazil (AGRM, WPC); Federal University of São Paulo, São Paulo, Brazil (FPM, FP, FFC); University of São Paulo, São Paulo, Brazil (MRC, TSB); and Federal University of Góias, Goiânia, Brazil (LLL). Originally submitted April 22, 2020. Revision received June 24, 2020. Accepted for publication July 9, 2020. Dr. Singh has received personal fees from Genentech/Roche, Alcon/Novartis, Zeiss, Bausch + Lomb, Ophthea, and Regeneron Pharmaceuticals, as well as grants from Apellis and Graybug. The remaining authors report no relevant financial disclosures. Dr. Singh did not participate in the editorial review of this manuscript. Address correspondence to Rishi P. Singh, MD, Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, i-32, Cleveland, OH 44195; email: singhr@ccf.org. doi: 10.3928/23258160-20201005-06

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