Abstract
Purpose Observation of ocular structures using microscope-integrated intraoperative optical coherence tomography (iOCT) has been adopted. Using the novel digital ophthalmic microscope, ARTEVO 800 with iOCT, we tested the feasibility of trabecular meshwork (TM) imaging during microhook ab interno trabeculotomy, a minimally invasive glaucoma surgery. Methods The nasal and temporal sides of the TM/inner wall of Schlemm's canal were incised more than 3 clock hours in 14 glaucomatous eyes of 10 patients. To observe the trabeculotomy site, iOCT was performed with the real-time five-line scan mode under observation using a Swan-Jacob gonioprism lens. The success of the imaging and visibility of the trabeculotomy cleft and its incisional patterns (i.e., anterior, middle, or posterior pattern) were determined by reviewing the iOCT video files. Results OCT images of the region of interest were acquired successfully in 100% of the 28 nasal or temporal sides in 14 eyes, although the trabeculotomy cleft was not visualized in four (14%) sides due to blockage of the OCT signal by a blood clot. Based on the predominant locations of the TM flaps in 24 of the acquired images, the trabeculotomy clefts were classified as anterior incisional patterns in 13 (54%), middle incisional patterns in nine (38%), and posterior incisional patterns in two (8%). Conclusion Intraoperative imaging of the gonio structures including the trabeculotomy cleft was feasible using the ARTEVO 800 with iOCT in combination with a gonioprism.
Highlights
Trabeculotomy is a glaucoma surgery that reduces intraocular pressure (IOP) by eliminating aqueous flow resistance by cleavage of the trabecular meshwork (TM) and inner walls of Schlemm’s canal at the point of outflow resistance of the aqueous humor
Using the RESCAN 700 and a gonioprism, Optical coherence tomography (OCT) images were not obtained in 17% of observations due to the lengthy time required to frame/focus the image [18]
Junker et al pointed out that one of the biggest problems associated with goniostructure imaging by intraoperative OCT (iOCT) is focusing on the region of interest [15]; iOCT of the gonio structures performed in combination with a gonioprism requires experience for successful image acquisition
Summary
Trabeculotomy is a glaucoma surgery that reduces intraocular pressure (IOP) by eliminating aqueous flow resistance by cleavage of the trabecular meshwork (TM) and inner walls of Schlemm’s canal at the point of outflow resistance of the aqueous humor. A new technique, i.e., the ab interno approach, for performing trabeculotomies has been reported recently in which the TM is incised or excised using specialized devices under direct observation of the anteriorchamber angle structure [1, 2]. E features of μLOT, which include conjunctival and scleral sparing with the ab interno technique, short surgical time, moderate IOP reduction, and no bleb-related complications, fulfill the conditions of minimally invasive glaucoma surgery (MIGS) [8]. Observation of the ocular microarchitectural structures using microscope-integrated intraoperative OCT (iOCT) was initially conducted using an external portable OCT system mounted on a microscope [9] and, more recently, using an OCT system integrated into surgical microscopes [10]. Observation of the ocular microarchitectural structures using microscope-integrated intraoperative OCT (iOCT) was initially conducted using an external portable OCT system mounted on a microscope [9] and, more recently, using an OCT system integrated into surgical microscopes [10]. iOCT was adopted initially in vitreoretinal surgery to assess macular holes and epiretinal membranes [10], in corneal surgery to visualize the donor cornea during
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