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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

4

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

5

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

11

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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13

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

(e) jsoque@hotmail.com

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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.

FINE