Audina Berrocal, MD: Impressions with Intraoperative OCT in 6-year-old male with FEVR & LRP5 positive gene

Professor, Audina (Nina) Berrocal, MD, is a busy retina specialist, who treats pediatric patients and trains Fellows, at Bascom Palmer Eye Institute, BPEI, and Jackson Memorial Hospital in Miami, FL. All patients are important to us; however, pediatric patients have additional needs because they are so young.

RetinaLink met with Dr. Berrocal to discuss her impressions of Io-OCT, Intraoperative OCT, in her operating room and how this new integrated real-time diagnostic is both a good teaching tool for Fellows and is advantageous because the surgeon can change their surgical plan prior to starting the case or during the surgery.

RetinaLink (RL): Has the ZEISS RESCAN changed your surgical workflow?
Audina Berrocal, MD (NB): The short answer is “yes” the ZEISS RESCAN has changed my surgical workflow. The caveat is it took me a long time to get used to it. We had our challenges at first; however, they are behind us now. There’s always a learning curve with any new technology and my OR staff needed the appropriate amount of time to get comfortable with Io-OCT. The more I use it the more I like it and want to use it during my cases.

One real advantage to RESCAN is that the foot pedal can be customized to the surgeon’s liking which is truly remarkable. Now, I can choose the view I would like to record. The more information you have yields a more educated surgical approach.

I also would like to mention that Zeiss provided great support to ensure proper integration in my operating room. They were patient with both surgeons and our staff and the end result is quite good. Patience is key and contacting Zeiss for additional support may allow a better transition to Io-OCT. 

RL: In your opinion, what are the benefits for your pediatric cases?

NB: During surgery it helps me understand the pathology and how what I’m doing surgically is affecting the tissues. I have changed surgery decisions when doing intraoperative OCT on complex retinal congenital diseases, for example, on a familial exudative vitreoretinopathy, known as FEVR, with its use I can peel the organized vitreous at the interface that otherwise I would feel more comfortable not maneuvering that much because of the difficulties in visualizing the membranes above the retina without the OCT. Especially it helps me to know when I have done enough or when I need to do more. As well it has been useful at the fluid air exchange, which interestingly shows that even when FAX seems to be complete there is always a little amount of subretinal fluid. It is simply that I have been understanding more of the complex anatomy of pediatric retinal detachments by using the Ia OCT on a routine basis. 

RL: Do you think RESCAN can be used as a teaching tool with your Fellows and will it be beneficial for younger surgeons?

NB: It’s important to understand that I spend a lot of time training Fellows. It’s critical when training Fellows in surgery that they can visualize the edge of the membrane. Once they see the Io-OCT, they can see the anatomic structure and “reassess” their technique and surgical plan. Honestly, RESCAN is a teaching tool for both the anterior and posterior segment. It can be used nicely for the lens, IOL, cornea and viewing the posterior pole. The increased visualization through Io-OCT allows me to discuss with my Fellows whether or not we should change our surgical plan ~ certainly very powerful information for Fellows to see real-time during their training. 

RL: Does the Io-OCT scan give you enough information to substitute RESCAN for a traditional EUA?

NB: In pediatric cases you have to do examinations under anesthesia so we can examine their eyes thoroughly, and sometimes perform surgeries at the same anesthesia event. At this point during EUA, anterior chamber can be examined using the OCT. Children can have structural abnormalities so examining their fovea with a handheld imaging probe allows us to better understand their anatomy. Posterior pole pathology is still something I am working on for enhancing the quality of the images obtained solely on EUA. 

RL: What surgical cases is RESCAN most useful for?

NB: honestly with every case. Subretinal bands are easy to visualize and certainly nice to see. Macular holes and retinal membranes are enhanced with Io-OCT. 

RL: As the technology continues to develop, where can you see it being utilized?

NB: Technology is amazing and continues to improve. Nobody could have imagined we would do more OCT’s now than FA’s. To have Io-OCT integrated into 3D OR platforms is outstanding. Advanced diagnostics like Io-OCT provide surgeons the opportunity to reassess the patient’s surgical plan real-time and for better visualization before and during surgery. 

 

 

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