Abstract
Introduction
Proliferative vitreoretinopathy (PVR) is a condition in which proliferation forms after rhegmatogenous retinal detachment (RRD) surgery or old RRD, and sometimes, PVR can occur under silicone oil (SO). Here, we report 2 cases of PVR in which we evaluated preoperative B-scan images of proliferation under SO using ultra-widefield swept-source OCT (UWF-SS-OCT).
Case Presentation
The first case was a 61-year-old male who presented with PVR under SO tamponade after multiple pars plana vitrectomies (PPVs) at the previous hospital, and the second case was a 23-year-old man patient who was diagnosed with Coats disease in childhood and presented with PVR under SO after PPV for total RRD at our hospital. B-scan images of UWF-SS-OCT provided findings of epiretinal two-layered proliferation or emulsified SO in the peripheral area.
Conclusion
UWF-SS-OCT is useful for preoperative assessment of the proliferation of PVR before SO removal. In addition, peculiar proliferation may occur in the eye under SO.
Keywords: Proliferative vitreoretinopathy, Retinal detachment, Silicon oil, Ultra-widefield OCT
Introduction
Proliferative vitreoretinopathy (PVR) is a disease complicated by the formation of proliferation following rhegmatogenous retinal detachment (RRD) surgery or old RRD [1]. It is useful to evaluate the depth and characteristics of proliferative tissue in order to decide the surgical strategy. Ultra-widefield swept-source OCT (UWF-SS-OCT) is a recently developed imaging device which can obtain B-scan images of the peripheral fundus [2]. In this report, we present 2 cases in which we evaluated preoperative B-scan images of proliferation under silicone oil (SO) using UWF-SS-OCT. The CARE Checklist has been completed by the authors for this case report, attached as online supplementary material (for all online suppl. material, see https://doi.org/10.1159/000542391).
Case Presentation
Case 1
A 61-year-old man was referred to our clinic after multiple pars plana vitrectomies (PPVs) with SO tamponade and additional encircling buckling procedures performed at the previous facility. He presented, however, with inferior shallow RD and retinal folding in three quadrants under SO tamponade (Fig. 1a). VA was 20/200 and IOP was 11 mm Hg. We utilized the volume mode of UWF-SS-OCT (Silverstone; Optos Plc), which provides us with 121 B-scan images of any 6 mm square area in continuous photographs. Furthermore, UWF-SS-OCT provided us with a B-scan image of epiretinal two-layered proliferation in the temporal peripheral area suspected to contain proliferation with fundus photography (Fig. 1b). Since postoperative proliferation should continue to extend even under SO, we decided to perform an additional revision. Intraoperative observations revealed that the epiretinal membrane-like (ERM-like) proliferation was difficult to grasp and peel with forceps due to their softness. SO removal, membrane dissection, endophotocoagulation, and 20% sulfur hexafluoride gas tamponade were performed and retinal attachment was successfully maintained for 1 year after surgery.
Fig. 1.
Preoperative UWF fundus photograph (a) and UWF-SS-OCT image (b) of case 1. a One (solid line) of 121 B-scan images temporal peripheral 6 × 6 mm square area (dotted line). b Epiretinal proliferation composed of two layers: the thick layer on the vitreous side (arrow) and the thin layer on the retinal side (arrowheads).
Case 2
A 23-year-old man, who was previously diagnosed with Coats disease and underwent photocoagulation and cryopexy in the left eye, presented with total RRD, neovascularization, and traction due to PVR. VA was 20/600 and IOP was 12 mm Hg. He underwent cataract surgery, encircling procedure, PPV, and SO tamponade. Six months postoperatively, he presented with recurrent ERM under SO. We utilized the volume mode of UWF-SS-OCT (Silverstone; Optos Plc) as in case 1 in the temporal peripheral area where proliferation was observed with fundus photography (Fig. 2a), and obtained a B-scan image of hyperreflective small spherical bodies trapped between ERM and retina (Fig. 2b). SO removal, membrane dissection, endophotocoagulation, and 14% perfluoropropane gas tamponade were performed. He underwent PPV again and retinal attachment was successfully maintained for 5 months postoperatively.
Fig. 2.
UWF fundus photograph (a) and UWF-SS-OCT image (b) before the second surgery of case 2. This UWF-SS-OCT image is a B-scan of solid line in the temporal peripheral 6 mm square (dotted line). Hyperreflective spherical bodies trapped between ERM and retina were observed (arrow).
Discussion
UWF-SS-OCT is an imaging device that combines the functionality of ultra-widefield fundus photography with swept-source OCT to obtain B-scan images of the peripheral retina. By specifying the location to be imaged after capturing images with an ultra-widefield fundus camera, B-scan images of the corresponding area can be obtained.
While reports exist of UWF-SS-OCT being used to capture and evaluate midperipheral retina in PVR [3, 4], this study is the first to capture and evaluate peripheral proliferative tissue in PVR under SO with UWF-SS-OCT as far as we know. Due to the limited depth of focus of OCT, obtaining high-resolution B-scan images can be challenging, particularly in cases of bullous retinal detachment. This study was able to obtain high-resolution peripheral B-scan images by limiting the focus to PVR under SO. The primary feature of this study is the ability to obtain high-quality B-scan images in PVR by focusing on cases under SO.
It is known that unique findings are observed under SO [5, 6]. In case 1, we obtained a B-scan image of two-layered epiretinal proliferation. The layer on the vitreous side consists of granulomatous lesions containing emulsified SO, and the layer on the retinal side is composed of the glial cells and extracellular matrix [5]. The layer on the vitreous side is sponge-like and fragile, so it is advisable to use not only forceps but also devices such as Diamond dust membrane scraper or Flex loop, which are sweep-type devices, in order to remove the fragile tissue. In case 2, hyperreflective small spherical bodies trapped between ERM and the retina were observed. These small spherical bodies were emulsified SO, these were likely to gain entrance between ERM and the retina through the intentional retinal hole or defect of the inner limiting membrane [6].
In conclusion, we were able to obtain B-scan images of proliferation specific to under SO and SO emulsion between ERM and retina in the peripheral fundus with UWF-SS-OCT. UWF-SS-OCT may be useful for preoperative assessment of pathology and in determining surgical strategy.
Statement of Ethics
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Ethical approval is not required for this study in accordance with national guidelines.
Conflict of Interest Statement
The authors have no conflicts of interest to declare.
Funding Sources
The authors have no funding to declare.
Author Contributions
Masaki Kinoshita reviewed medical records and wrote the original draft of case reports. Susumu Sakimoto revised and edited the manuscript. Masaki Suzue, Masanori Kanai, Nobuhiko Shiraki, and Kohji Nishida supervised the study.
Funding Statement
The authors have no funding to declare.
Data Availability Statement
All data generated or analyzed during this study are included in this published article its online supplementary material files. Further inquiries can be directed to the corresponding author.
Supplementary Material.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
All data generated or analyzed during this study are included in this published article its online supplementary material files. Further inquiries can be directed to the corresponding author.