DOI: 10.5061/dryad.h44j0zpnp
title: Accuracy of biomicroscopy, ultrasonography and spectral-domain OCT in detection of complete posterior vitreous detachment

description: Purpose: To evaluate the accuracy of pre-operative biomicroscopy (BM),
 ultrasonography (US), and spectral domain optical coherence tomography
 (SD-OCT) for determining complete posterior vitreous detachment (PVD)
 confirmed by intraoperative findings of triamcinolone acetonide-assisted
 pars plana vitrectomy (PPV). Design: This was a prospective, consecutive,
 interventional case series. Methods: The study included all patients
 admitted for surgical treatment of epiretinal membrane (ERM) and macular
 hole (MH). Presence of complete PVD was determined one day before PPV
 using BM, US, and SD-OCT. Preoperative findings were compared to PVD
 status determined during PPV. Results: A total of 123 eyes of 123 patients
 were included in the study. Indications for PPV included ER in 57
 (46.34%), full thickness macular hole in 57 (46.34%), and lamelar macular
 hole in 9 (7.32%) patients. Complete PVD during PPV was observed in 18
 (31.58%; 95% CI:18.72–49.91) patients with ERM and 13 (19.7%; 95% CI:
 10.49–33.68) patients with MH. Vitreoschisis was present in 30 (24.39%;
 95% CI: 15.46–34.82) patients during PPV. The sensitivity of preoperative
 BM, US, SD-OCT was 48.4% (95% CI: 30.2–66.9), 61.3% (95%CI: 42.2–78.2) and
 54.8% (95% CI: 36.0–72.7) respectively. The specificity of preoperative
 BM, US, SD-OCT was 81.5% (95% CI: 72.1–88.9), 90.2% (95% CI: 82.2–95.4)
 and 85.9% (95% CI: 77.0–92.3) respectively. With a prevalence of 25.2% of
 PVD in our sample the positive predictive value of preoperative BM, US,
 SD-OCT was 46.9% (95% CI: 29.1–65.3), 67.9% (95% CI: 47.6–84.1) and 56.7%
 (37.4–74.5) respectively. Conclusion: Preoperative BM, US, and SD-OCT are
 associated with poor sensitivity and a rather good specificity for
 detecting complete PVD.  There is relatively a high percentage of
 patients with vitreoschisis undergoing vitreoretinal surgery, therefore
 vitreoretinal surgeons should consider routine usage of triamcinolone in
 all vitreoretinal cases.
description: This was a prospective,
 consecutive, interventional case series based at the tertiary care
 Department of Ophthalmology, University Clinical Center Tuzla, Bosnia and
 Herzegovina. The study included all patients admitted for surgical
 treatment of epiretinal membrane (ERM) and macular hole (MH) in the period
 from January 1, 2015, to December 31, 2019. Exclusion criteria were age
 younger than 18, dense cataract or opaque ocular media that precluded
 fundus visualization, vitreous haze or bleeding, history of ocular trauma,
 and previous vitrectomy. The current study was approved by the University
 Clinical Center Tuzla Ethics Committee. Written informed consent was
 obtained from all patients after receiving an explanation of the
 investigative nature and intent of the study and tenets of the Helsinki
 Declaration were followed. As a part of preoperative preparation, all
 patients underwent a complete systemic evaluation which included general
 laboratory findings and a complete systemic examination to identify
 systemic diseases and drug use. In order to minimize the risk of
 spontaneous PVD all eligible patients underwent a complete preoperative
 ophthalmological assessment (BM, US, and SD-OCT) one day before the
 surgery. The first independent investigator performed slit-lamp BM with
 fully dilated pupils using a 78D lens (Volk Optical Inc., Enterprise Drive
 Mentor, OH, USA). A PVD was identified by the presence of a Weiss ring and
 or the definitively detached visible posterior hyaloid membrane. It was
 classified as presence or absence of PVD on BM. 
 The second independent
 investigator performed ocular US using UD-800 (Tomey, Nagoya, Japan). Both
 vertical and horizontal views were used and the mobility of the posterior
 vitreous was examined during saccadic eye movements with a high gain (90
 dB), real-time, through-the-lid contact technique. A PVD status was
 considered when posterior vitreous cortex was well defined and completely
 separated from the retina situated posterior to the equator and at the
 optic nerve head. It was classified as presence or absence of PVD in
 US. Spectral-domain OCT images were obtained with
 fully dilated pupils using Cirrus HD-OCT (Carl Zeiss Meditec, Inc.,
 Dublin, CA) with the Macular Cube Scans (200x200) accompanying automatic
 centering at the fovea. An
 acceptable image quality was 8 and above, and adequate scan position was
 if the top of the scan was at least two “nasal retina thicknesses” above
 the retinal pigment epithelium at the foveal center.10 Both investigators
 interpreted OCT scans independently in a masked fashion. Posterior
 vitreous detachment was confirmed on OCT when a hyperreflective linear
 signal was clearly separated from the neuroretina. Disagreement regarding
 PVD status was resolved by joint review of the macular scans. It was
 classified as presence or absence of PVD in OCT.
 All results of preoperative
 examinations were compared with the findings of triamcinolone-assisted 23
 gauge 3-port pars plana vitrectomy (PPV) performed on the following day.
 All surgeries were performed using Constellation (Alcon Laboratories, TX,
 USA) and recorded with a recording camera. After initial core vitrectomy
 triamcinolone was injected and posterior vitreous cortex was evaluated.
 Attached vitreous was considered when firm vitreous attachment that had to
 be removed by vitreous cutter suction was noted during the surgery. After
 complete vitrectomy all patients underwent internal limiting membrane
 (ILM) peeling and the gas tamponade based on surgical indication. The
 evaluation of PVD status was performed during the surgery and on the
 surgical video by both examiners. It was classified as presence or absence of PVD
 during PPV. Binary and categorical variables are reported as
 absolute numbers and percentages, and were tested for differences between
 groups defined by the PPV-confirmed PVD status using the chi-squared
 test.  Sensitivity, specificity, positive predictive value, and negative
 predictive value were calculated for the BM, US and SD-OCT findings, using
 a PPV as a gold standard. Univariable and multivariable receiver operating
 characteristics (ROC) to obtain the values of the area under the curve
 (AUC) and corresponding 95% confidence intervals (95% CI) were based on
 logistic regression models predicting the PPV-confirmed PPD result.
 Multivariable models were adjusted for sex and age. AUCs were compared
 using deLong test. All the analyses were performed using Stata version
 15.1 (StataCorp, College Station, Texas, USA). The significance level for
 hypothesis testing was set to 0.05.
description: # Accuracy of biomicroscopy, ultrasonography and spectral-domain OCT in
 detection of complete posterior vitreous detachment
 ### GENERAL INFORMATION
 1. Title of Dataset: ACCURACY OF BIOMICROSCOPY, ULTRASONOGRAPHY AND
 SPECTRAL-DOMAIN OCT IN DETECTION OF COMPLETE POSTERIOR VITREOUS DETACHMENT
 2. Author Information ​A. Principal Investigator Contact Information
 ​​Name: ​​​Jasmin Zvorničanin ​​Institution: ​​- Department of
 Ophthalmology, University Clinical ​​​​​Centre ​Tuzla, Tuzla, Bosnia and
 Herzegovina - Faculty of Health Studies, University of Bihać, Bihać,
 Bosnia and Herzegovina ​​Address: ​​Ulica dr Ibre Pašića bb, 75000 Tuzla,
 B&H ​​Email: ​​​ ​B. Associate
 or Co-investigator Contact Information ​​Name: ​​​Edita Zvorničanin
 ​​Institution: ​​- Private Healthcare Institution Vase zdravlje, Tuzla,
 ​​​​​Bosnia and Herzegovina  ​​Address: ​​Ulica Ismeta Mujezinovića br 27,
 75000 Tuzla, B&H ​​Email: ​​​ B.
 Associate or Co-investigator Contact Information ​​Name: ​​​Maja Popović
 Institution: ​- Cancer Epidemiology Unit, Department of Medical Sciences,
 University of Turin and CPO-Piemonte ​​Address: ​​Via Santena 7, Turin
 10125, Italy ​​Email: ​​​ 3. Date of data
 collection: ​1st January 2015 to 31st December 2019. 4. Geographic
 location of data collection: Tuzla Canton, Bosnia and Herzegovina
 5. Information about funding sources that supported the collection of the
 data: No funding was received for this research. SHARING/ACCESS
 INFORMATION 1. Licenses/restrictions placed on the data: NONE 2. Links to
 publications that cite or use the data: In review  3. Links to other
 publicly accessible locations of the data: NONE. 4. Links/relationships to
 ancillary data sets: NONE. 5. Was data derived from another source? NO.
 6. Recommended citation for this dataset: Zvorničanin, Jasmin;
 Zvorničanin, Edita; Popović, Maja (2022), Accuracy of biomicroscopy,
 ultrasonography and spectral-domain OCT in detection of complete posterior
 vitreous detachment, Dryad, Dataset,
 https://doi.org/10.5061/dryad.h44j0zpnp   DATA & FILE OVERVIEW 1. File
 List: Accuracy_of_BM_US_and_SD_OCT_in_detection_of_complete_PVD
 2. Relationship between files, if important: NONE. 3. Additional related
 data collected that was not included in the current data package:​ NONE.
 4. Are there multiple versions of the dataset? ​​NO. METHODOLOGICAL
 INFORMATION 1. Description of methods used for collection/generation of
 data:  As a part of preoperative preparation, all patients underwent
 complete systemic evaluation which included general laboratory findings
 and a complete systemic examination to identify systemic diseases and drug
 use. In order to maximize the chance of achieving the appropriate vitreous
 evaluation, a complete preoperative ophthalmological assessment (BM, US
 and SD-OCT) was performed the day before surgery. First independent
 investigator performed slit-lamp BM with fully dilated pupils using a 78D
 lens (Volk Optical Inc., Enterprise Drive Mentor, OH, USA). A PVD was
 identified by the presence of a Weiss ring and or the definitively
 detached visible posterior hyaloid membrane. It was classified as presence
 or absence of PVD on BM.  The second independent investigator performed
 ocular US using UD-800 (Tomey, Nagoya, Japan). Both vertical and
 horizontal views were used and the mobility of the posterior vitreous was
 examined during saccadic eye movements with a high gain (90 dB),
 real-time, through-the-lid contact technique [12]. A PVD status was
 considered when posterior vitreous cortex was well defined and completely
 separated from the retina situated posterior to the equator and at the
 optic nerve head. It was classified as presence or absence of PVD in US.
 Spectral domain OCT images were obtained with fully dilated pupils using
 Cirrus HD-OCT (Carl Zeiss Meditec, Inc., Dublin, CA) with the Macular Cube
 200 × 200 Combo protocol. The protocol consisted of two perpendicular line
 scans centred at the fovea followed by a cube scan also centred at the
 fovea. The line scans were 6 mm in the transverse direction, had a 2-mm
 axial depth, and were composed of 1 000 axial scans each. The cube scan
 was 6×6 mm, had a 2-mm axial depth, and was composed of 200×200 axial
 scans. The rationale for applying this protocol has been found in the fact
 that the use of 6 mm macular SD-OCT scans without including the optic
 nerve in the scan area can accurately distinguish partial from complete
 PVD, as long as the scans are centred and not shifted superiorly [17].
 Therefore, the SD-OCT scans were considered to have an acceptable position
 if the top of the scan was at least three “retina thicknesses” above the
 retinal pigment epithelium at the foveal centre with the image quality of
 8 and above. Retina thickness was measured at the nasal edge of the
 horizontal scan for each eye unless this retina was pathologically
 thickened or thinned, in which case a temporal edge was selected. This
 criterion was selected to capture the anterior edge of
 the premacular bursa. Both investigators interpreted SD-OCT scans
 independently in a masked fashion. Posterior vitreous detachment was
 confirmed on SD-OCT when a hyperreflective linear signal was clearly
 separated from the neuroretina. Disagreement regarding PVD status was
 resolved by joint review of the macular scans. It was classified as
 presence or absence of PVD in OCT. All results of preoperative
 examinations were compared with the findings of triamcinolone assisted 23
 gauge 3-port pars plana vitrectomy (PPV) performed on the following day.
 All surgeries were performed using Constellation (Alcon Laboratories, TX,
 USA) and recorded with a recording camera. After initial core vitrectomy,
 4mg/0.1ml of triamcinolone acetonide suspension (40mg/ml; Krka-Farma,
 Zagreb, Croatia) was injected and posterior vitreous cortex evaluated.
 Vitreous was considered attached when firm vitreous attachment that had to
 be removed by vitreous cutter suction was noted during the surgery. After
 complete vitrectomy all patients underwent internal limiting membrane
 (ILM) peeling and the gas tamponade based on surgical indication. In
 patients with ERM, the ERM peeling was performed first, followed by
 staining and peeling of the ILM. The evaluation of PVD status was
 performed during the surgery and on the surgical video by both examiners
 [8,13]. It was classified as the presence or absence of PVD during PPV.
 2. Methods for processing the data: Binary and categorical variables are
 reported as absolute numbers and percentages and were tested for
 differences between groups defined by the PPV-confirmed PVD status using
 the Chi-squared test.  Sensitivity, specificity, positive predictive
 value, and negative predictive value were calculated for the BM, US and
 SD-OCT findings, using a PPV as a gold standard. Univariable and
 multivariable receiver operating characteristics (ROC) to obtain the
 values of the area under the curve (AUC) and corresponding 95% confidence
 intervals (95% CI) were based on logistic regression models predicting the
 PPV-confirmed PPD result. Multivariable models were adjusted for sex and
 age. AUCs were compared using deLong test.  3. Instrument- or
 software-specific information needed to interpret the data: The data
 were analyzed using Stata Statistical Software, version
 15.1 (StataCorp LP, College Station, Texas, USA).  4. Standards and
 calibration information, if appropriate: NONE.
 5. Environmental/experimental conditions: NONE. 6. Describe any
 quality-assurance procedures performed on the data: All data was double
 checked when data was acquired and entered in excel file. 7. People
 involved with sample collection, processing, analysis and/or submission:
 Jasmin Zvorničanin, Edita Zvorničanin and Maja Popović DATA-SPECIFIC
 INFORMATION
 FOR:[Accuracy_of_BM_US_and_SD_OCT_in_detection_of_complete_PVD] 1. Number
 of variables: ​23 2. Number of cases/rows: ​123 3. Variable List:
 1\) Age – age of included patients at the time of the surgery.
 2\) Gender - Male or Female.​ 3\) Side – Right or Left.​
 4\) Indication - According to the indication for surgery, the data were
 classified into threegroups: FTMH – full thickness macular
 hole, Lamelar MH – lamellar macular hole and ERM – epiretinal membrane.
 5\) Indication_coded - Patients were grouped into two groups based on the
 indication: 1 – FTMH or Lamelar MH and 0 – ERM. 6\) IOP – Measured
 intraocular pressure in millimeters of mercury (mm Hg).
 7\) IOP20​- Patients were grouped into two groups based on the intraocular
 pressure (IOP) pressure: 1 – higher than 20 mm Hg and 0 – lower than 20
 mm Hg 8\) Glaucom - Patients were grouped into two groups based on
 the glaucoma presence on the hospital admission. ​ 9\) Monokulus –
 patients that operated their only functional eye.​
 10\) Lensstatus - Patients were grouped into two groups based on
 the crystalline status (presence): cataract or posterior chamber
 intraocular lens (PCIOL) 11\) VA - Visual acuity of operated eye at the
 hospital admission (decimal category). 12\) VAbetter01 - Patients were
 grouped into two groups based on the visual acuity of the operated eye: 1
 – better than 0.1 and 0 – worse than 0.1. 13\) VAbetter03 - Patients were
 grouped into two groups based on the visual acuity of the operated eye: 1
 – better than 0.3 and 0 – worse than 0.3. 14\) OtherEyeVA - Visual
 acuity of other eye at the hospital admission (decimal category).
 15\) OtherEyeWors03 - Patients were grouped into two groups based on the
 visual acuity of the other eye: 1 – better than 0.3 and 0 – worse than
 0.3. 16\) LAX – axial length of operated eye measured in millimeters. 
 17\) IOL – dioptric power of theoretical intraocular lens planed for the
 surgery. 18\) LAXcateg2350 - Patients were grouped into two groups based
 on the axial length: 1 – axial length longer than 23.5 mm and 0 – axial
 length shorter than 23.5 mm.​ 19\) Vitrectomy – Patients were grouped in
 two groups based on the presence of Posterior Vitreous Detachment during
 surgery as described in Methods.​ 20\) Ophthalmoscopy - Patients were
 grouped in two groups based on the presence of Posterior Vitreous
 Detachment during ophthalmoscopy as described in Methods.​
 21\) Ultrasound - Patients were grouped in two groups based on the
 presence of Posterior Vitreous Detachment
 during ultrasonography as described in Methods.​​ 22\) OCT - Patients were
 grouped in two groups based on the presence of Posterior Vitreous
 Detachment during Optical Coherence Tomography as described in Methods.
 23\) Vitreoshisis - Patients were grouped in two groups based on
 the presence of vitreoshisis during surgery.   4. Missing data codes: NONE
   5. Specialized formats or other abbreviations used: * ERM – epiretinal
 membrane * FTMH – full thickness macular hole * PCIOL – posterior chamber
 intraocular lens