Rescan 700

Three-port 25-gauge transconjunctival sutureless vitrectomy was performed using the Constellation Vision Surgical System (Alcon Surgical, Fort Worth, TX, USA). Core vitrectomy and peripheral vitreous shaving with removal of vitreous traction and proliferative membranes were performed first, and endolaser photocoagulation was applied to the retina. SO (5500 Centistoke, Arcadophta, Toulouse, France) was injected after fluid-air exchange. SO was used at the surgeon’s discretion in cases with vigorous bleeding or severe tractional retinal detachment caused by fibrovascular membranes or their removal.
The eyes were divided according to whether ILM peeling was performed during SO injection surgery (group 1) or during SO removal surgery (group 2). All ILM peeling was assisted with triamcinolone (MaQaid^®, Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan). In all cases, an area of ILM measuring approximately 6 mm in diameter (equivalent to the entire ETDRS sector area) was peeled at the posterior pole of the retina. The surgery was completed after confirmed absence of any traces of ILM or macular hole using intraoperative OCT (RESCAN 700, Zeiss, Oberkochen, Germany) in all patients.

Standard three-port vitrectomy was performed using a 23-gauge system (DORC, Zuidland, The Netherlands) by a single surgeon (M. M.) in all patients. Phacoemulsification with intraocular lens (IOL) implantation was performed if a visually significant cataract was present. After core and peripheral vitrectomy, the ILM was stained with 0.025% Brilliant Blue G (Brilliant Peel, Fluoron, Germany). A potentially present ERM was differentiated from the ILM by its staining pattern and peeled consequently. In all cases, the I-ILM flap cover technique was performed creating a radial I-ILM flap (I-ILM flap rosette) to cover the FTMH [40 (link), 41 (link)]. At the end of the surgery, 12% perfluoropropane (C3F8; Perfluoron, Alcon Laboratories, Fort Worth, TX, USA) was substituted in all cases. All patients were instructed to maintain a face-down position for 3 days after surgery. Dynamic intraoperative imaging with the microscope integrated iSD-OCT system Rescan 700 (Carl Zeiss Meditec AG, Oberkochen, Germany) was used to reassure a safe and controlled surgery with correct flap positioning at the end of surgery.

A standard ophthalmic surgery microscope equipped with an OCT engine (LUMERA 700 with RESCAN 700, Carl Zeiss Meditec, München, Germany) was used for all experiments. Two OCT B-scans in a cross formation were continuously captured by the microscope at a desired location controlled by the surgeon using a foot control pedal or by the assistant using the auxiliary screen. The surgical field was directly observed through the microscope’s eyepiece with the two B-scans and an OCT acquisition location marker overlaid onto the scene.

A single surgeon (DDH) performed all the surgeries. A 3-port 25-gauge scleral tunnel transconjunctival sutureless PPV was performed using the Constellation Vision Surgical System (Alcon Surgical, Fort Worth, TX, USA). It was performed under 2% lidocaine sub-Tenon anesthesia with monitored anesthesia care. Phacoemulsification with posterior chamber intraocular lens implantation was also performed in patients with cataract. After the core vitrectomy, the peripheral vitreous was thoroughly shaved using scleral indentation. The subretinal fluid was drained through the preexisting peripheral retinal breaks after filling perfluorocarbon liquid (PFCL, Decaline® 7 mL, FCI SAS, Paris, France) up to the posterior edge of the break. Endophotocoagulation around the breaks on the peripheral retina was then applied. Following PFCL removal and fluid-air exchange, the surgery was completed after confirmation of the reattachment of retina and absence of any epiretinal membrane and macular hole using the intraoperative OCT (RESCAN 700, Zeiss, Germany) in all patients. After that, in all cases, gas endo-tamponade (C3F8, 10% perfluoropropane) was performed and those patients were then recommended to maintain a prone position for one week after surgery.

A RESCAN 700 (Carl Zeiss AG, Oberkochen, Germany) was used for intraoperative imaging, and SD-OCT was used for scanning imaging. For intraoperative SD-OCT image export, the ImageJ software (version 1.48) was used for processing, and the scanning depth was adjusted to 2.0 mm. The distance between the posterior surface of EVO-ICL and the anterior lens capsule was measured. All measurements were conducted three times, and the average values were recorded, namely the intraoperative vaulting values.