Abstract
Ophthalmic procedures demand precise surgical instrument control in depth, yet standard operating microscopes supply limited depth perception. Current commercial microscope-integrated optical coherence tomography partially meets this need with manually-positioned cross-sectional images that offer qualitative estimates of depth. In this work, we present methods for automatic quantitative depth measurement using real-time, two-surface corneal segmentation and needle tracking in OCT volumes. We then demonstrate these methods for guidance of ex vivo deep anterior lamellar keratoplasty (DALK) needle insertions. Surgeons using the output of these methods improved their ability to reach a target depth, and decreased their incidence of corneal perforations, both with statistical significance. We believe these methods could increase the success rate of DALK and thereby improve patient outcomes.
Highlights
Optical coherence tomography (OCT) produces micrometer-scale tomographic images of both the anterior and posterior segments of the human eye [1]
Versions of microscope integrated OCT (MICOT) systems were restricted to real-time two-dimensional imaging [4, 6, 7, 9, 14,15,16], but research prototype systems can acquire, process, and render three-dimensional OCT data in real-time [12, 17,18,19,20,21,22,23]
MIOCT has demonstrated its utility for both visualizing ophthalmic surgical procedures and enhancing surgeon performance in ex vivo depth-based tasks [4, 12, 25,26,27,28,29,30,31,32]
Summary
Optical coherence tomography (OCT) produces micrometer-scale tomographic images of both the anterior and posterior segments of the human eye [1]. Earlier studies showed the impact of OCT imaging during surgery or for examination of patients under anesthesia using handheld systems separate from the operating microscope for imaging [2, 3]. Research groups and commercial entities have integrated OCT systems into surgical operating microscopes to provide direct visualization of ophthalmic surgery in real-time [4,5,6,7,8,9,10,11,12,13,14,15,16]. Surgeons are able to view the OCT images in their operating microscopes via heads up displays (HUDs) [10, 11, 14,15,16, 24]. MIOCT has demonstrated its utility for both visualizing ophthalmic surgical procedures and enhancing surgeon performance in ex vivo depth-based tasks [4, 12, 25,26,27,28,29,30,31,32]
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