Abstract
PurposeTo demonstrate key integrative advances in microscope-integrated intraoperative optical coherence tomography (iOCT) technology that will facilitate adoption and utilization during ophthalmic surgery.MethodsWe developed a second-generation prototype microscope-integrated iOCT system that interfaces directly with a standard ophthalmic surgical microscope. Novel features for improved design and functionality included improved profile and ergonomics, as well as a tunable lens system for optimized image quality and heads-up display (HUD) system for surgeon feedback. Novel material testing was performed for potential suitability for OCT-compatible instrumentation based on light scattering and transmission characteristics. Prototype surgical instruments were developed based on material testing and tested using the microscope-integrated iOCT system. Several surgical maneuvers were performed and imaged, and surgical motion visualization was evaluated with a unique scanning and image processing protocol.ResultsHigh-resolution images were successfully obtained with the microscope-integrated iOCT system with HUD feedback. Six semi-transparent materials were characterized to determine their attenuation coefficients and scatter density with an 830 nm OCT light source. Based on these optical properties, polycarbonate was selected as a material substrate for prototype instrument construction. A surgical pick, retinal forceps, and corneal needle were constructed with semi-transparent materials. Excellent visualization of both the underlying tissues and surgical instrument were achieved on OCT cross-section. Using model eyes, various surgical maneuvers were visualized, including membrane peeling, vessel manipulation, cannulation of the subretinal space, subretinal intraocular foreign body removal, and corneal penetration.ConclusionsSignificant iterative improvements in integrative technology related to iOCT and ophthalmic surgery are demonstrated.
Highlights
optical coherence tomography (OCT) has revolutionized the clinical practice of ophthalmology
Anterior segment and vitreoretinal surgical procedures have been imaged with intraoperative OCT (iOCT), and macular holes, vitreomacular traction, retinal detachment, and epiretinal membranes have all been visualized with iOCT in early foundational studies [2,3,4,5,6,7,8,9]
Intrasurgical feedback using iOCT during lamellar keratoplasty procedures has been described [10,11,12,13]
Summary
OCT provides non-invasive high-resolution optical biopsy of tissue microstructure that facilitates disease diagnosis and guides therapeutic decision-making [1]. Seamless integration of this technology into ophthalmic surgery has the potential to be the foundation for a new paradigm in the surgical management of ophthalmic disease. Over the last several years, intraoperative OCT (iOCT) has emerged as a viable adjunct to ophthalmic surgery. Intrasurgical feedback using iOCT during lamellar keratoplasty procedures has been described [10,11,12,13]
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