1. macular hole 2. epiretinal membrane 3. retinal ... pars plana vitrectomy, 25 gauge erm peel /...
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James B Soque, CRA, OCT-C, COA
Island Retina
Shirley, New York
GENENTECH
Ophthotech
ThromboGenics
Notal Vision
REGENERON
Island Retina, Shirley, New York
Dr. Pamela A. Weber
Staff and Technicians at Island Retina
www.island-retina.com
1. Name 3 surgeries where OCT imaging can have impact on a successful outcome
2. Describe the important structures that should be imaged prior to surgery
3. Outline the techniques (4) needed for successful OCT imaging in anticipation of surgical intervention.
1. Macular Hole
2. Epiretinal Membrane
3. Retinal Detachment
4. Diabetic Retinopathy
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3
Born – perfectly clear.
Age 9-10; degeneration begins
Liquefaction occurs
Water leaves the eye and congealing begins
Posterior Vitreous Detachment - Observe the activity of the Posterior Hyaloid
Stage 1
Stage 2
Stage 3
Complete PVD
Born – perfectly clear.
Age 9-10; degeneration begins
Liquefaction occurs
Water leaves the eye and congealing begins
Posterior Vitreous Detachment - Observe the activity of the Posterior Hyaloid
Stage 1
Stage 2
Stage 3
Complete PVD
INCOMPLETE PVD – When danger can occur!
v
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EPIS or EZ or IS/OS junction- ellipsoid portion of the inner segment
COST or IZ- cones outer segment tips line or Interdigitation Zone H.E. OCT2, 85,000 Hz Scan
H.E. OCT2, 85,000 Hz Scan
H2O
H.E. OCT2, 85,000 Hz Scan
Stage 1 PVD
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Mechanical component to eye disease and damage of the VR interface
Adherence of the Posterior Vitreous to the Retina at the VR Interface
CONTRACTION OCCURS
Posterior Vitreous/Posterior Hyaloid Contraction
Epiretinal Membrane Contraction
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Müller Cells
Heinrich Müller (17 December 1820 – 10 May 1864) was a German anatomist and professor at the University of Würzburg. He is best known for his work in comparative anatomy and his studies involving the eye.
Franz Christian Boll (1849–1879)- Recognizes Müller ‘s work.
Charles Marie Benjamin Rouget (1824–1904), identified "Müller-Rouget muscle“, named in honor of both men. “Electrical conductivity” of cells.
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Elongated Cell – 8 to 10 Million/Eye.
Vertical (Y Axis) span from ILM to the ROS.
Functions:
Metabolic
Structural
Neuroprotective Function
Scale = 1 um
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Place the pathology in the path of the beam
‘Relocate the Beam’ – Drag Method
‘Rotate the Beam’ – Change Axis
‘Relocate Pathology’ – Use Eye Steering and put pathology IN THE PATH OF THE BEAM.
Use a “Longer than Normal Beam” to capture pathology
Ensure that the ‘Run Off’ of the beam encompasses both Normal Retina and Abnormal Retina.
Phakic
Small Hole
No ERM
Adhesion is small.
ILM peel is possible.
Face down positioning is ‘possible’.
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10
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20 – 30 microns
Rotate 90 degrees
Adhesion of Posterior Hyaloid
Incomplete separation of Anomalous PVD.
Non Release of Post Hyaloid in Periphery and Optic Nerve Head
Retinal Breaks
Retinal Tears/Hole
Retinal Detachment
Rotate 45 degrees
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Pars Plana Vitrectomy, 25 Gauge
ERM Peel / Macular Hole Closure
ILM Peel
Retinal Detachment
AF X, Air Fluid Exchange.
Gas X, SF6 or C3F8 [8 - 20%]
Diabetic Retinopathy Membranes – Membrane Peel
Seal the Heme, PRP Laser, Gas Tamponade
Internal Limiting Membrane has to be peeled in order to ensure the success of flattening of the retina in Macular Hole and Epiretinal Membrane Surgery.
Triamcinolone, 4 mg ml
ICG Green Dye 5 mg per ml, 1 min incubation.
Loop Scraper
Diamond Dusted Scraper
Micro Forceps
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Identify the disease or disorder requiring to be scanned.
Know the limits of your SD OCT Device
Study the behavior of The Vitreous!
Scan the Diseased retina
Scan the nearby Normal retina
Scan for surgical technique to be performed.
Thank You
Pluto: July 2015
Pluto’s Heart NV AMD OD: March 2015
“New Horizon” Spacecraft: July 2015 84
James B. Soque, CRA, OCT-C, COA
Chief of Photography, Imaging Specialist
Island Retina
www.Island-Retina.com
1500 William Floyd Parkway, Ste. 304
Shirley, New York, 11967
(o) 631 924 4300 (f) 631 924 2525
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http://www.hindawi.com/crim/ophthalmological.medicine/2013/713061
Wakely L, et al., A comparison of macular hole measurement using optical coherence tomography, and their value in predicting anatomical and visual outcomes. Br J Ophth, 2012, 96:1003-7.
https://en.wikipedia.org/wiki/Heinrich_M%C3%BCller_(physiologist)
http://webvision.med.utah.edu/imageswv/CajalMuller.jpeg
http://retinatoday.com/2016/06/vitreous-the-next-frontier/
http://www.retinalphysician.com/issues/2017/april-2017/new-product-applications
Landa G., et al., External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis, EYE, 2012 (1):61-69
http://thesis.library.caltech.edu/974/3/CSN_CH3.pdf
Huang. Available at http://www.ophmanagement.com/article.aspx?article=102795. Accessed July 1, 2010
http://www.retinareference.com/diseases/5377ff5d5247a147/images/5377ff5d52/
http://webvision.med.utah.edu/book/part-ii-anatomy-and-physiology-of-the-retina/glial-cells-of-the-retina/
Esmaeelpour, Marieh; Ansari-Shahrezaei, Siamak; Kellner, Lukas; Krebs, Ilse; Binder, Susanne (9 June 2014). "Choroidal Haller's and Sattler's Layer Thickness Measurement Using 3-Dimensional 1060-nm Optical Coherence Tomography"
Huang D, Swanson EA, Lin CP, et al. Optical coherence tomography. Science. 1991;254(5035):1178-1181.
Wojtkowski M et al. Ophthalmic imaging by spectral optical coherence tomography. Am J Ophthalmol. 2004 Sep;138(3):412-9.
https://www.reviewofoptometry.com/ce/know-your-retinal-breaks-tears-and-holes
https://www.hindawi.com/journals/bmri/2014/351804/
http://www.justretina.com/Patients/Education/brochures_files/pfo_giant_tear8.png
http://www.ultrasoundvillage.com/files/Retinal_Detachment_main.jpg
http://img.medscapestatic.com/pi/meds/ckb/74/7474tn.jpg
Adaptive-Müller-cell-responses-to-microglial-activation-mediate-neuroprotection-and-coordinate-1742-2094-8-173-S2.ogv Author: Wang M, Ma W, Zhao L, Fariss R, Wong W, 2011.
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