The Use of Optical Coherence Tomography as an Intraoperative Adjunct of Oculoplastic Surgery.

Implantable electronic cardiovascular device such as cardiac pacemakers and implantable defibrillators are common life-saving devices. Device-related complications can arise when undergoing surgical interventions with electrosurgical tools due to electromagnetic interference, based on electrocautery type, implantable electronic cardiovascular device type, electrocautery location, and a number of other factors. The risk of device-related complications due to electrocautery in oculoplastic surgery has not been established. This systematic literature review assesses prevalence, risk factors, and outcomes of electrocautery-related device complications in oculoplastic surgery. Systematic literature review followed Preferred Reporting Items for Systematic and Meta-Analysis guidelines and used the search terms "pacemaker," "implantable cardioverter defibrillator," "electrocautery," "cautery," and "electrosurgery" through June 2022. Inclusion criteria were full-text articles, discussing ocular, oculoplastic, or other facial surgery. Exclusion criteria were non-English language or surgery focused on other parts of the body. Full-text manuscripts of identified articles were reviewed and relevant data were extracted. Twelve studies met inclusion criteria. Two studies were level I and II evidence, while 10 studies were level III or IV. There were no reports of electromagnetic interference with bipolar cautery use. With monopolar cautery use, cases of electromagnetic interference were reported, but without related significant morbidity or mortality. Safety recommendations to minimize electrical flow through the implantable electronic cardiovascular device are described. There were no reports of implantable electronic cardiovascular device-related complications from bipolar or thermocautery use in ophthalmic or oculoplastic surgeries. Monopolar have been associated with electromagnetic interference, but additional preoperative and perioperative measures can be taken to mitigate this risk.

To evaluate the feasibility and utility of intraoperative optical coherence tomography (OCT) during pars plana vitrectomy surgery for dense vitreous hemorrhage. The Prospective Assessment of Intraoperative and Perioperative OCT for Ophthalmic Surgery study examined the utility of intraoperative OCT in ophthalmic surgery. Intraoperative scanning was performed with a microscope-mounted spectral domain OCT system. This report is a case series of those eyes undergoing pars plana vitrectomy for dense central vitreous hemorrhage that precluded preoperative OCT assessment. Intraoperative OCT images were qualitatively evaluated for retinal abnormalities that might impact intraoperative or perioperative management. Clinical variables were collected and assessed. Surgeon assessment of intraoperative OCT utility was also evaluated. Twenty-three eyes were identified and included. The etiology for the vitreous hemorrhage was proliferative diabetic retinopathy (19 eyes, 82.6%), horseshoe retinal tear (1 eye, 4.3%), retinal vein occlusion with neovascularization (1 eye, 4.3%), presumed polypoid choroidal vasculopathy (1 eye, 4.3%), and presumed retinal arterial macroaneurysm (1 eye, 4.3%). Intraoperative OCT revealed epiretinal membrane (14 eyes, 60.9%), macular edema (14 eyes, 60.9%), posterior hyaloid traction (1 eye, 4.3%), and retinal detachment (1 eye, 4.3%). Surgeon feedback suggested that intraoperative OCT impacted surgical decision making in eyes where membrane peeling was performed. Intraoperative OCT during pars plana vitrectomy for vitreous hemorrhage may provide physicians with clinically relevant information that may impact surgical management, perioperative management, and patient outcomes.

The Prospective Intraoperative and Perioperative Ophthalmic ImagiNg With Optical CoherEncE TomogRaphy (PIONEER) Study: 2-Year Results

Optical coherence tomography (OCT) has become one of indispensable imaging techniques in ophthalmology. OCT makes far-reaching influence on correct diagnosis, disease assessment, and prognosis evaluation after surgery in various ocular diseases. At present, the application scope of OCT is further expended and gradually being applied to a variety of ocular surgeries. This application is named as intraoperative OCT (iOCT). iOCT not only helps us to come to a better understanding and recognition of ocular diseases from a new perspective, but also influences our decision making of the surgical plan, thus improving safety and success rate of ocular surgery to a great extent. We reviewed the history of iOCT and its application in ocular surgery in this paper.

The Ophthalmic Plastic Surgery Library

To determine the rate of perforation of surgical gloves after ophthalmic surgery and to identify factors that contribute to the development of perforations. Case-control study of used and unused surgical gloves collected during a 7-month period. The ophthalmology surgical suites of a major teaching hospital. Development of glove perforations as measured by five different techniques. We tested 103 pairs of latex surgical gloves before use and 454 pairs of gloves after use. Of five techniques used to test for pinholes, air inflation with water submersion and compression was found to be the most sensitive, yielding a 6.80% prevalence in control glove pairs and a 21.81% prevalence in study glove pairs (P = .0005). When examined by subspecialty area, the lowest perforation rate (11.39%; P = .00009) occurred in cataract and intraocular lens surgery and the highest rate (41.67%; P = .003) occurred in oculoplastic surgery. Factors that correlated significantly with the development of perforations as determined by multiple logistic regression analysis included pediatric ophthalmology and strabismus surgeries, oculoplastic surgeries, level of training of the surgeon, duration of operation, and larger glove size. The thumb and index fingers of the nondominant hand contained the largest numbers of pinholes. The rate of surgical glove perforation after ophthalmic surgery is relatively high. Recommendations for reducing the rate of glove perforation are discussed.

Optical coherence tomography (OCT) has transformed the clinical management of a myriad of ophthalmic conditions. Applying OCT to ophthalmic surgery may have implications for surgical decision making and patient outcomes. To assess the feasibility and effect on surgical decision making of a microscope-integrated intraoperative OCT (iOCT) system. Report highlighting the 1-year results (March 2014-February 2015) of the RESCAN 700 portion of the DISCOVER (Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery) study, a single-site, multisurgeon, prospective consecutive case series regarding this investigational device. Participants included patients undergoing ophthalmic surgery. Data on clinical characteristics were collected, and iOCT was performed during surgical milestones, as directed by the operating surgeon. A surgeon questionnaire was issued to each surgeon and was completed after each case to evaluate the role of iOCT during surgery and its particular role in select surgical procedures. Percentage of cases with successful acquisition of iOCT (ie, feasibility). Percentage of cases in which iOCT altered surgical decision making (ie, utility). During year 1 of the DISCOVER study, a total of 227 eyes (91 anterior segment cases and 136 posterior segment cases) underwent imaging with the RESCAN 700 system. Successful imaging (eg, the ability to acquire an OCT image of the tissue of interest) was obtained for 224 of 227 eyes (99% [95% CI, 98%-100%]). During lamellar keratoplasty, the iOCT data provided information that altered the surgeon's decision making in 38% of the cases (eg, complete graft apposition when the surgeon believed there was interface fluid). In membrane peeling procedures, iOCT information was discordant with the surgeon's impression of membrane peel completeness in 19% of cases (eg, lack of residual membrane or presence of occult membrane), thus affecting additional surgical maneuvers. The DISCOVER study demonstrates the feasibility of real-time iOCT with a microscope-integrated iOCT system for ophthalmic surgery. The information gained from iOCT appears to allow surgeons to assess subtle details in a unique perspective from standard en face visualization, which can affect surgical decision making some of the time, although the effect of these changes in decision making on outcomes remains unknown. A prospective randomized masked trial is needed to confirm these results.

The Use and Fate of Fascia Lata and Sclera in Ophthalmic Plastic and Reconstructive Surgery: The 1980 Wendell Hughes Lecture

To investigate the effects of the COVID-19 pandemic on case volumes and wait-times for ophthalmic surgery in Ontario, Canada. Population-based retrospective cohort study. Patients undergoing ophthalmic surgery in Ontario, Canada, from 2010 to 2021, collected from the Ontario Health Wait Times Information System (WTIS) database. The WTIS contains non-emergent surgical case volume and wait-time data for six ophthalmic subspecialty surgery types, three priority levels (low, medium, high) and 14 different regions in Ontario. Case volume and wait-times were compared between the COVID-19 pandemic (2020-2021) and the preceding time period (2010-2019) across all stratifications. There was a significant decrease in case volumes and significant increase in wait-times across geographic regions, priority levels, and subspecialty surgeries from the pre-pandemic to pandemic period. Moreover, COVID-19 exacerbated pre-existing wait-time disparities between sexes, with females waiting 4.1 days longer than males overall to receive surgery in 2010-2019 compared to waiting 8.8 days longer in 2020-2021 (117% increase). These findings highlight the impact of the COVID-19 pandemic on ophthalmic surgical wait times in Ontario. Cataract, strabismus and oculoplastic surgeries, the Waterloo Wellington, Central, and South East regions of Ontario, and those with female sex had the greatest relative increases in wait-times during the pandemic.

The subspecialty of ophthalmic plastic surgery was born in the mid-twentieth century in the United States at the conclusion of World War II. The art of oculoplastic surgery, however, is centuries old, bearing its roots in antiquity in India, the Far East, and Europe. The principles and basic techniques that have been improved upon and refined over the years are inherent in the disciplines of ophthalmology and plastic surgery. Thus, a history of ophthalmic plastic surgery is inevitably a history of the development of both fields. The various procedures that have evolved over centuries can be divided into several general categories: reconstructive, restorative, and cosmetic. Each of these categories deals with restoring or enhancing structure as well function to damaged or malfunctioning adnexal structures. Numerous adnexal structures make up the periorbita, and throughout time, oculoplastic surgeons have perfected, refined, and pioneered new techniques of lacrimal surgery, ptosis repair and blepharoplasty, orbital surgery, lid malpositions, and flaps and grafts. Oculoplastic surgery became recognized as a unique subspecialty of ophthalmology at the end of World War II. Numerous orbital and periocular injuries were treated by general ophthalmologists without prior training or exposure to ophthalmic plastic surgery. For these surgeons, review of the existing literature, exchange of experiences with colleagues and across disciplines, and, more often than not, trial and error were keys in developing these procedures. After the war, interest in the subfield of ophthalmic surgery grew, and eventually, an organized association dedicated solely to the field of ophthalmic plastic surgery was formed. This chapter is a testament to those great minds that weaved the broad array of ophthalmic techniques into a quilt of a distinct subspecialty.

The subspecialty of ophthalmic plastic surgery was born in the mid-twentieth century in the United States at the conclusion of World War II. The art of oculoplastic surgery, however, is centuries old, bearing its roots in antiquity in India, the Far East, and Europe. The principles and basic techniques that have been improved upon and refined over the years are inherent in the disciplines of ophthalmology and plastic surgery. Thus, a history of ophthalmic plastic surgery is inevitably a history of the development of both fields. The various procedures that have evolved over centuries can be divided into several general categories: reconstructive, restorative, and cosmetic. Each of these categories deals with restoring or enhancing structure as well function to damaged or malfunctioning adnexal structures. Numerous adnexal structures make up the periorbita, and throughout time, oculoplastic surgeons have perfected, refined, and pioneered new techniques of lacrimal surgery, ptosis repair and blepharoplasty, orbital surgery, lid malpositions, and flaps and grafts. Oculoplastic surgery became recognized as a unique subspecialty of ophthalmology at the end of World War II. Numerous orbital and periocular injuries were treated by general ophthalmologists without prior training or exposure to ophthalmic plastic surgery. For these surgeons topic literature, exchange of experiences with colleagues and across disciplines, and more often than not, trial and error were keys in developing these procedures. After the war, interest in the subfield of ophthalmic surgery grew, and eventually, an organized association dedicated solely to the field of ophthalmic plastic surgery was formed. This chapter is a testament to those great minds that weaved the broad array of ophthalmic techniques into a quilt of a distinct subspecialty.

Intraoperative Optical Coherence Tomography–Assisted Descemet Membrane Endothelial Keratoplasty in the DISCOVER Study

Background: Methicillin-resistant Staphylococcus aureus (MRSA) decolonization is widely utilized in many medical subspecialities to reduce surgical site infections, but routine ophthalmic implementation has been limited. The aim of this study was to investigate the attitudes and actual practice of corneal specialists and oculoplastic surgeons toward MRSA decolonization as a preventive measure in ophthalmic surgery. Materials and Methods: A web-based survey was sent to cornea specialists and oculoplastic surgeons to assess their knowledge, beliefs, and practices regarding MRSA prophylaxis and the use of MRSA decolonization to prevent post-operative infections. Results: A total of 180 surgeons participated in this study: 71% of respondents agreed that MRSA colonization plays a role in post-operative infection of the eye and adnexal structures; 65% stated that MRSA decolonization could help prevent MRSA infection. Although 41% of respondents would change their management in response to a positive pre-operative MRSA screening result, only 18% performed pre-operative screening. Seventeen percent of respondents indicated that they offer pre-operative decolonization for MRSA-positive patients; the most frequently applied technique was the use of nasal antibiotic agents such as mupirocin, followed by antiseptic baths. Peri-operative MRSA prophylaxis was used by 18% of respondents; pre-operative MRSA decolonization was used in conjunction by 8.5 % of respondents. Conclusions: Although MRSA decolonization has been validated in fields outside of ophthalmology, there has not been widespread adoption of this practice among oculoplastic surgeons and cornea specialists. Prospective MRSA decolonization ophthalmic studies are necessary if evidence-based management guidelines are to be developed.

.Significance: Surgical microscopes provide adjustable magnification, bright illumination, and clear visualization of the surgical field and have been increasingly used in operating rooms. State-of-the-art surgical microscopes are integrated with various imaging modalities, such as optical coherence tomography (OCT), fluorescence imaging, and augmented reality (AR) for image-guided surgery.Aim: This comprehensive review is based on the literature of over 500 papers that cover the technology development and applications of surgical microscopy over the past century. The aim of this review is threefold: (i) providing a comprehensive technical overview of surgical microscopes, (ii) providing critical references for microscope selection and system development, and (iii) providing an overview of various medical applications.Approach: More than 500 references were collected and reviewed. A timeline of important milestones during the evolution of surgical microscope is provided in this study. An in-depth technical overview of the optical system, mechanical system, illumination, visualization, and integration with advanced imaging modalities is provided. Various medical applications of surgical microscopes in neurosurgery and spine surgery, ophthalmic surgery, ear-nose-throat (ENT) surgery, endodontics, and plastic and reconstructive surgery are described.Results: Surgical microscopy has been significantly advanced in the technical aspects of high-end optics, bright and shadow-free illumination, stable and flexible mechanical design, and versatile visualization. New imaging modalities, such as hyperspectral imaging, OCT, fluorescence imaging, photoacoustic microscopy, and laser speckle contrast imaging, are being integrated with surgical microscopes. Advanced visualization and AR are being added to surgical microscopes as new features that are changing clinical practices in the operating room.Conclusions: The combination of new imaging technologies and surgical microscopy will enable surgeons to perform challenging procedures and improve surgical outcomes. With advanced visualization and improved ergonomics, the surgical microscope has become a powerful tool in neurosurgery, spinal, ENT, ophthalmic, plastic and reconstructive surgeries.

The advent of optical coherence tomography (OCT) has revolutionized our diagnostic and therapeutic capabilities in ophthalmology and vitreoretinal disease. In the clinic setting, OCT has touched nearly every aspect of vitreoretinal disease. More recently, OCT has been introduced the operating room theater. Intraoperative OCT (iOCT) has been used to successfully further our understanding of optic pit maculopathy, macular holes, epiretinal membranes, and retinopathy of prematurity.1–6 Limited systems are available for intraoperative use. All commercially available systems are handheld OCT devices or modified tabletop units, which allow for intraoperative imaging but require cessation of the surgical procedure to complete imaging. This precludes real-time feedback to the surgeon of the anatomical impact of surgical maneuvers and increases the duration of the surgical procedure. A microscope-mounted/integrated OCT (MMOCT) system allows for the integration of OCT into the real-time surgical platform.7,8 At the time of this report, two unique prototype systems have been described in the literature.5,7,8 Using a prototype MMOCT system, we previously demonstrated the feasibility of intraoperative imaging of surgical instruments, retinal effects of surgical contact, and primarily static surgical steps.7 To further seamlessly integrate OCT into the surgical platform, visualization of intraoperative motion and manipulation will be critical. Another critical component of integration will include the rapid localization of the surgical area of interest with the intraoperative spectral domain OCT (SD-OCT) device and quantitative information regarding the relative locations of the surgical instruments to the retinal tissue layers of interest. In this report, we describe a novel technique for visualizing intraoperative motion of surgical instruments with an MMOCT system.