PMC7548865_01
Introduction of the 39G flexible cannula into the subretinal space in the superior macula area and injection of balanced salt solution into the subretinal space.
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During surgery, a 39-gauge flexible cannula was used to inject subretinal balanced salt solution (BSS) superior to the fovea (Figure 1), detaching the entire foveo-macula area (Figure 2).
Detachment of the foveomacular retina using the slow injection of balanced salt solution into the subretinal space.
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During surgery, a 39-gauge flexible cannula was used to inject subretinal balanced salt solution (BSS) superior to the fovea (Figure 1), detaching the entire foveo-macula area (Figure 2).
Initiating the epiretinal membrane peel from the macula area.
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A thick ERM was peeled from the detached macula (Figures 3 and 4).
Peeled off epiretinal membrane.
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A thick ERM was peeled from the detached macula (Figures 3 and 4).
Line scans showing preserved subfoveal ellipsoid zone (EZ), external limiting membrane (ELM), and retinal pigment epithelium (RPE). There is a parafoveal bubble of PFCL and retina edema. ERM is also present.
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Figures 5-7, show the subretinal location of the PFCL bubble, and intraretinal cystic spaces. Figure 5 represents the parafoveal location of the PFCL, while Figure 6 is the subfoveal migration. While there is subfoveal ellipsoid zone (EZ) and external limiting membrane (ELM) in Figure 5, these layers are disrupted in Figures 6 and 7. Also, a layer of ERM is present in the preoperative Figures 5 and 6, but absent in Figure 7.
Line scans showing interrupted subfoveal ellipsoid zone (EZ) and external limiting membrane (ELM) over the large bubble of subfoveal PFCL. ERM is also present.
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Figures 5-7, show the subretinal location of the PFCL bubble, and intraretinal cystic spaces. Figure 5 represents the parafoveal location of the PFCL, while Figure 6 is the subfoveal migration. While there is subfoveal ellipsoid zone (EZ) and external limiting membrane (ELM) in Figure 5, these layers are disrupted in Figures 6 and 7. Also, a layer of ERM is present in the preoperative Figures 5 and 6, but absent in Figure 7.
Line scans showing an absence of subfoveal ellipsoid zone (EZ) and photoreceptor layer and replacement by drusenoid materials which are likely degenerated photoreceptors. The RPE layer is present.
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Figures 5-7, show the subretinal location of the PFCL bubble, and intraretinal cystic spaces. Figure 5 represents the parafoveal location of the PFCL, while Figure 6 is the subfoveal migration. In Figure 7 the post-operative microstructure of the retina is imaged. While there is subfoveal ellipsoid zone (EZ) and external limiting membrane (ELM) in Figure 5, these layers are disrupted in Figures 6 and 7. In Figure 7, there is the presence of subfoveal RPE; the photoreceptors in the subfoveal area are replaced by drusen like material which is most likely degenerated photoreceptors. Also, a layer of ERM is present in the preoperative Figures 5 and 6, but absent in Figure 7.
6 X 6 OCTA of parafoveal PFCL. Hypo auto fluorescent areas are seen as a result of projection artifacts which arise due to the large PFCL bubble. However, there are fairly intact superficial and deep vascular plexi. The foveal avascular zone (FAZ) is noted to be present. Also, choriocapillaris layer shows a well-circumscribed circular area of hyper fluorescence surrounded by hypo fluorescent boundaries.
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Preoperative OCTA of the parafoveal PFCL bubble in Figure 8 showed the deep capillary plexus was intact. The choriocapillaris layer no longer had the previous hyper- and hypo-reflective areas described in the preoperative image's Figures 8 and 9.
3 X 3 OCTA of subfoveal PFCL. Superficial plexus can be imaged and appears intact. The foveal avascular zone (FAZ) is also present. The choriocapillaris shows similar findings as in figure 8.
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In the preoperative subfoveal OCTA scans in Figure 9 the superficial capillary plexus could be imaged with some difficulty and showed intact vasculature. The choriocapillaris layer no longer had the previous hyper- and hypo-reflective areas described in the preoperative image's Figures 8 and 9.
8 X 8 OCTA of postoperative macular. Projection artifacts are present in the superficial plexus. Both superficial and deep plexi appear to be intact and choriocapillaris appears normal. FAZ is present but irregular. In the outer retina, there is a wedge-shaped area of hyper fluorescence in the superior temporal area, which is suggestive of outer retina damage. Also, the ellipsoid zone and photoreceptor layer are absent and replaced by drusenoid material which are likely degenerated photoreceptors. The RPE layer is present.
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Postoperative OCTA image in Figure 10, suggests there was an improvement in the overall ability to image the vasculature of the retina as shown by improved imaging of the deep and superficial capillary plexus.