1118hrs: Macular Surgery (David Maberley)
/Dr Maberley is also local faculty from UBC.
ERM, MH, SMH our most common elective retinal surgeries. OCT has been pivotable in defining our approach to these diseases from identifying the condition to confirming the surgical goals post-op.
Caveats of OCT and Visual Acuity related to diabetes. VA does not correlate well with OCT retinal thickness.
Thickening of inner retinal layer with corrugations along stress lines. CME often a factor too. Prior vascular conditions such as macular venous occlusion may have occurred. Chronicity difficult to identify. Key to talking with patient as those presenting with metamorphopsia tend to have a better prognosis.
OCT and cataract assessment before consider surgery. Often best to do the cataract/IOL first if cataract present to avoid additional surgeries. If not convinced of peripheral retina tear, could have RPE disruption that may only be found with IVFA.
If peel ILM, need to make sure get broad area. If membrane the only problem, best to not peel the ILM off. Head positioning sometimes an issue post-op. Patient can notice horizontal line from the air/fluid level. 100% risk cataract within 2 years if >50 yo.
Macular Hole well defined by OCT to confirm the diagnosis, measure diameter and perifoveal changes, and confirm proper closure post-op. IVFA may still be needed in some patients.
Goes through Don Gass’s original description of macular hole when thought to be tangential but now know more perifoveal and more vertical.
Over 90% holes should close with overage vision improved to 6/15 or so with surgery. Goes through other stats for success rates under different macular hole causes.
Next deals with subretinal haemmhrage. Difficult to tell if subfoveal especially by angiogram but OCT able to show sub-foveal. Therefore suggests management different with need to displace the blood.