Effect of macular optical coherence tomography on decision making before silicone oil removal

Abstract

Purpose To evaluate the role of spectral domain optical coherence tomography (SD-OCT) in affecting the decision making in eyes prepared for silicon oil removal (SOR) and to identify the cases that should have an obligatory preoperative SD-OCT. Patients and methods This prospective nonrandomized study involved patients with silicone-filled eyes recruited over the period from 2015 to 2018. Data from preoperative clinical examination and SD-OCT imaging and proposed modifications on SOR surgery based on both ways of examinations were recorded and compared. Cohen’s Kappa test was used to study the agreement between the clinical and OCT results. Results A total of 146 eyes of 138 patients were included in the study. Before SOR, clinical examination revealed normal macula in 108 (74%) eyes compared with 62 (42%) by OCT. OCT was able to detect significantly higher macular pathologies than did the clinical examination alone (P<0.0005). The number of eyes with macular edema (ME) and epiretinal membrane detected by OCT was significantly higher than that detected clinically (P<0.0005). There was a weak agreement between the results of clinical and OCT examination regarding ME (weighted K=0.426). Modifications added to the routine SOR based on clinical findings were suggested in 25 (17%) eyes compared with 65 (45%) eyes on adding OCT findings in decision making. Superadded modifications based on SD-OCT alone were significantly more in diabetic than nondiabetic patients regarding management of ME and macular retinal detachment (P=0.003). Conclusion SD-OCT was proved to be a helpful tool for following silicone-filled eyes, especially in diabetic patients. Preoperative OCT findings influenced the surgical plans of the routine SOR, thus aided in managing treatable macular lesions such as epiretinal membrane, ME, macular holes, and macular detachment.