Intraoperative microscope-mounted spectral domain optical coherence tomography for evaluation of retinal anatomy during macular surgery.

OBJECTIVE: To evaluate the use of microscope mounted spectral domain optical coherence tomography (SD-OCT) to detect changes in retinal anatomy during macular surgery. DESIGN: Retrospective, observational case series. PARTICIPANTS: We included 25 eyes of 24 consecutive patients who underwent SD-OCT during macular surgery. METHODS: A retrospective review of operative techniques, outcomes, and imaging for all patients who underwent intraoperative microscope mounted SD-OCT during surgery for macular hole or epiretinal membrane (ERM) from April 2009 to April 2010 was performed. Qualitative and quantitative characteristics of intraoperative and postoperative changes in retinal anatomy were studied. MAIN OUTCOME MEASURES: Intraoperative change in macular hole dimensions and retinal thickness in patients with ERM owing to surgical manipulation measured using SD-OCT. RESULTS: Intraoperative SD-OCT from 13 eyes of 13 patients undergoing surgery for macular hole was reviewed. Two cases had images of suboptimal quality and were excluded. The remaining 11 eyes were subjected to quantitative analysis, which revealed stability of macular hole height and central hole diameter after internal limiting membrane (ILM) peeling, but an increase in the diameter of subretinal fluid under the macula in ten of 11 eyes (average 87% wider). Intraoperative imaging from 12 eyes of 11 patients undergoing surgery for ERM was analyzed. Quantitative analysis revealed an average increase of retinal thickness after ILM peel of <2%. Ten of 12 eyes developed a new subretinal hyporeflectance, which likely represents shallow detachment of the macula, after uncomplicated membrane peel. CONCLUSIONS: Use of intraoperative SD-OCT has provided new insight into the changes to retinal anatomy during macular surgery and may prove to be a useful tool for vitreoretinal surgery. Further study is warranted to determine whether intraoperative changes such as the creation of shallow retinal detachments during uncomplicated macular surgery affects visual recovery. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Hemangiopericytoma of the optic nerve sheath.

PURPOSE: To report the clinicopathologic findings in patient with optic nerve sheath hemangiopericytoma. DESIGN: Clinicopathologic report. METHODS: The clinical, histologic, and immunohistochemical findings of a patient with optic nerve sheath hemangiopericytoma were reviewed. RESULTS: An excisional biopsy of an optic nerve sheath tumor from a 35-year-old woman showed a staghorn vascular pattern consisting of CD34-positive tumor cells. CONCLUSIONS: Hemangiopericytoma may occur rarely in the optic nerve sheath.

Methicillin-resistant Staphylococcus aureus infectious scleritis after vitrectomy for endophthalmitis.

PURPOSE: To report a case of methicillin-resistant Staphylococcus aureus infectious scleritis after vitrectomy for endophthalmitis. METHODS: Retrospective chart review of one patient referred to a tertiary academic center for management of methicillin-resistant S. aureus infectious scleritis. Antecedent history, clinical course, response to treatment, and final visual acuity were documented. RESULTS: Methicillin-resistant S. aureus infectious scleritis required combination systemic, periocular, intraocular, and topical antibiotics for complete resolution. Visual recovery was limited. CONCLUSION: Methicillin-resistant S. aureus infectious scleritis can complicate vitrectomy for endophthalmitis and requires long-term and multiple-route administration of antibiotics for resolution. Greater awareness of this serious complication along with preventive measures may reduce future occurrences.

Topical ketorolac in vitreoretinal surgery: a prospective, randomized, placebo-controlled, double-masked trial.

OBJECTIVE: To evaluate the effects of topical ketorolac in patients undergoing vitreoretinal surgery. METHODS: One hundred nine patients undergoing vitrectomies were randomized to receive either topical ketorolac tromethamine, 0.4%, or placebo. Patients were instructed to begin taking the study medication 3 days preoperatively (4 times daily) and to continue taking it 4 weeks postoperatively. MAIN OUTCOME MEASURES: Intraoperative pupil diameter, postoperative day 1 pain and inflammation, 1-month postoperative retinal thickness, and preoperative and 1-month postoperative best-corrected visual acuities. RESULTS: The difference in mean pupil diameters between patients using ketorolac and those taking placebo was 0.06 mm (P = .39). Patients taking ketorolac and those taking placebo had mean pain scores (scale, 1-10) of 0.24 (SD, 0.6) and 1.06 (SD, 2) (P = .03) and mean inflammation grades (grade, 0-4) of 0.59 (SD, 0.7) and 1.16 (SD, 0.9) (P < .001), respectively. Ketorolac reduced central subfield thickness by 8%, but this was not statistically significant. At 1 month, mean visual acuities improved to 0.40 logMAR units (mean Snellen, 20/50; SD, 0.28 logMAR units) in the ketorolac group from 0.83 logMAR units (20/150(+2); SD, 0.60 logMAR units) at baseline and to 0.67 logMAR units (20/100(+1); SD, 0.46 logMAR units) in the placebo group from 0.92 logMAR units (20/150(-2); SD, 0.62 logMAR units) at baseline (P = .001). CONCLUSIONS: Topical ketorolac was well tolerated and safe, reduced postoperative pain and inflammation, and improved visual recovery in this prospective, double-masked trial. APPLICATION TO CLINICAL PRACTICE: Topical ketorolac may benefit patients undergoing vitreoretinal surgery. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00576329.