Intrasurgical Assessment of Subretinal tPA Injection for Submacular Hemorrhage in the PIONEER Study Utilizing Intraoperative OCT

BACKGROUND AND OBJECTIVE: To assess the feasibility of intraoperative OCT (iOCT) during pars plana vitrectomy with subretinal tissue plasminogen activator (tPA) injection for subretinal hemorrhage. PATIENTS AND METHODS: Eyes that underwent vitrectomy and subretinal injection of tPA were identified from the PIONEER study, a prospective clinical study assessing the feasibility and utility of iOCT in ophthalmic surgery. A microscope-mounted spectral-domain OCT system was utilized for iOCT imaging. Standardized scan protocol and image acquisition were followed for intraoperative imaging. RESULTS: iOCT was successfully obtained in four of four eyes. In all cases, increased subretinal fluid was noted, with differential reflectivity visualized between the hemorrhage-tPA interface confirming appropriate localization of tPA injection. Image quality variability was significant. CONCLUSION: iOCT can successfully be performed during pars plana vitrectomy with subretinal tPA injection. Utilizing iOCT, appropriate placement of tPA solution and corresponding retinal architectural changes were visualized.