March 2022: VBS Literature Update
Hwang ES, Kraker JA, Griffin KJ, Sebag J, Weinberg DV, Kim JE. Accuracy of spectral-domain OCT of the macula for detection of complete posterior vitreous detachment. Ophthalmol Retina. 2020;4(2):148-153.
Abstract by Daniel Su, MD
Using OCT to Detect a Complete PVD
Posterior vitreous detachment (PVD), an age-related separation of vitreous from the retina, is an important variable that factors into surgical decision-making. For example, preoperative PVD status may affect the surgical approach of retinal detachment repair with pneumatic retinopexy, scleral buckle, or vitrectomy. When the PVD status is in question, ultrasound is often used to confirm the presence of PVD. Some studies have shown that optical coherence tomography (OCT) can be used to detect eyes with no PVD by visualizing the premacular bursa and to detect eyes with partial PVD by visualizing the posterior hyaloid face. Because OCT is almost universally obtained as part of preoperative assessment, the accuracy of PVD diagnosis by OCT is an important topic of investigation. In this study, Hwang et al. evaluated the accuracy of preoperative OCT of the macula for determining PVD status in comparison with intraoperative findings during vitrectomy.
In this retrospective chart review, PVD status on operative notes were compared with preoperative OCT scans. Spectral-domain OCT scans of the macula were obtained using either the Heidelberg Spectralis, Topcon 3DOCT, or Zeiss Cirrus 5000. Two masked investigators independently graded PVD status and any interobserver disagreements were resolved by joint review of the OCT scans. A grading scale was used to categorize PVD stages 0, 1, 2, 3, 4 and abnormal with 0-3. Stage 4 was categorized separately as a complete PVD. Abnormal was categorized together as absence of PVD. The OCT scans utilized a 6-mm OCT scan over the macula and did not include the optic nerve.
One hundred and seventy-five eyes of 175 patients were included. Of these, 137 were categorized as attached vitreous and 38 as complete PVD. Of the 38 eyes graded as complete PVD by OCT, 20 eyes were found to have a complete PVD intraoperatively (true-positive result), and 18 eyes were found to have attached posterior hyaloid at the time of surgery (false-positive result). Of the 137 eyes categorized as attached vitreous by OCT, 129 eyes showed attached vitreous intraoperatively (true-negative result) and 8 eyes showed pre-existing PVD at time of surgery (false-negative result). The sensitivity of OCT for detecting a complete PVD was 71% and specificity was 88%. The positive predictive value was 53% and the negative predictive value was 94%.
OCT is almost universally obtained as part of any preoperative assessment and its ability to evaluate PVD status accurately was studied in this report. Based on this report, OCT had poor sensitivity (71%) in detecting a full PVD but had good specificity (88%) in ruling out a full PVD. Visualization of the posterior hyaloid face on OCT provides helpful guidance when planning for retinal detachment repair and may guide a surgeon towards a scleral buckle instead of vitrectomy or pneumatic retinopexy. However, if neither the premacular bursa nor the posterior vitreous cortex are visualized, OCT has poor predictive value on the presence of a full PVD.
Overview
Learning Objectives
Upon completion of this activity, the participant should be able to:
- Identify optical coherence tomography (OCT) features that correlate with the presence of a complete posterior vitreous detachment (PVD)
- Understand the ability of standard spectral-domain OCT to accurately detect a complete PVD
Accreditation
Provided by Evolve Medical Education
Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Evolve Medical Education, LLC and Vit Buckle Society. Evolve Medical Education, LLC is accredited by the ACCME to provide continuing medical education for physicians.Credit Designation Statement
Evolve Medical Education LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Participation Method
In order to obtain credit, proceed through the program, complete the post-test, evaluation and submit for credit.
Faculty and Disclosures
Daniel Su, MD
Retina-Vitreous Associates Medical Group
Los Angeles, CADISCLOSURE POLICY
It is the policy of Evolve that faculty and other individuals who are in the position to control the content of this activity disclose any real or apparent financial relationships relating to the topics of this educational activity. Evolve has full policies in place that will identify and mitigate all financial relationships prior to this educational activity.The following faculty/staff members have the following financial relationships with ineligible companies.
Daniel Su, MD, has no financial relationships with ineligible companies.
The Evolve staff and planners have no financial relationships with ineligible companies.
Nisha Mukherjee, MD, peer reviewer, has no financial relationships with ineligible companies.Disclaimer
OFF-LABEL STATEMENT
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.DISCLAIMER
The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Evolve or Vit Buckle Society.System Requirements
- Supported Browsers (2 most recent versions):
- Google Chrome for Windows, Mac OS, iOS, and Android
- Apple Safari for Mac OS and iOS
- Mozilla Firefox for Windows, Mac OS, iOS, and Android
- Microsoft Edge for Windows
- Recommended Internet Speed: 5Mbps+
Publication Dates
Expiration Date:
Ready to Claim Your Credits?
You have attempts to pass this post-test. Take your time and review carefully before submitting.
Good luck!