Paul Hahn1, Oscar Carrasco-Zevallos2, David Cunefare2, Justin Migacz2, Sina Farsiu3, Joseph A Izatt2, Cynthia A Toth3. 1. Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA. 2. Department of Biomedical Engineering, Duke University, Durham, NC, USA. 3. Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA ; Department of Biomedical Engineering, Duke University, Durham, NC, USA.
Abstract
PURPOSE: To characterize the first in-human intraoperative imaging using a custom prototype spectral-domain microscope-integrated optical coherence tomography (MIOCT) device during vitreoretinal surgery with instruments in the eye. METHODS: Under institutional review board approval for a prospective intraoperative study, MIOCT images were obtained at surgical pauses with instruments held static in the vitreous cavity and then concurrently with surgical maneuvers. Postoperatively, MIOCT images obtained at surgical pauses were compared with images obtained with a high-resolution handheld spectral-domain OCT (HHOCT) system with objective endpoints, including acquisition of images acceptable for analysis and identification of predefined macular morphologic or pathologic features. RESULTS: Human MIOCT images were successfully obtained before incision and during pauses in surgical maneuvers. MIOCT imaging confirmed preoperative diagnoses, such as epiretinal membrane, full-thickness macular hole, and vitreomacular traction and demonstrated successful achievement of surgical goals. MIOCT and HHOCT images obtained at surgical pauses in two cohorts of five patients were comparable with greater than or equal to 80% correlation in 80% of patients. Real-time video-imaging concurrent with surgical manipulations enabled, for the first time using this device, visualization of dynamic instrument-retina interaction with targeted OCT tracking. CONCLUSION: MIOCT is successful for imaging at surgical pauses and for real-time image guidance with implementation of targeted OCT tracking. Even faster acquisition speeds are currently being developed with incorporation of a swept-source MIOCT engine. Further refinements and investigations will be directed toward continued integration for real-time volumetric imaging of surgical maneuvers. TRANSLATIONAL RELEVANCE: Ongoing development of seamless MIOCT systems will likely transform surgical visualization, approaches, and decision-making.
PURPOSE: To characterize the first in-human intraoperative imaging using a custom prototype spectral-domain microscope-integrated optical coherence tomography (MIOCT) device during vitreoretinal surgery with instruments in the eye. METHODS: Under institutional review board approval for a prospective intraoperative study, MIOCT images were obtained at surgical pauses with instruments held static in the vitreous cavity and then concurrently with surgical maneuvers. Postoperatively, MIOCT images obtained at surgical pauses were compared with images obtained with a high-resolution handheld spectral-domain OCT (HHOCT) system with objective endpoints, including acquisition of images acceptable for analysis and identification of predefined macular morphologic or pathologic features. RESULTS: Human MIOCT images were successfully obtained before incision and during pauses in surgical maneuvers. MIOCT imaging confirmed preoperative diagnoses, such as epiretinal membrane, full-thickness macular hole, and vitreomacular traction and demonstrated successful achievement of surgical goals. MIOCT and HHOCT images obtained at surgical pauses in two cohorts of five patients were comparable with greater than or equal to 80% correlation in 80% of patients. Real-time video-imaging concurrent with surgical manipulations enabled, for the first time using this device, visualization of dynamic instrument-retina interaction with targeted OCT tracking. CONCLUSION: MIOCT is successful for imaging at surgical pauses and for real-time image guidance with implementation of targeted OCT tracking. Even faster acquisition speeds are currently being developed with incorporation of a swept-source MIOCT engine. Further refinements and investigations will be directed toward continued integration for real-time volumetric imaging of surgical maneuvers. TRANSLATIONAL RELEVANCE: Ongoing development of seamless MIOCT systems will likely transform surgical visualization, approaches, and decision-making.
Entities:
Keywords:
OCT; human imaging; intraoperative; microscope-integrated; microscope-mounted; real-time; spectral-domain optical coherence tomography; tracking; vitreoretinal surgery
Authors: G Hüttmann; E Lankenau; C Schulz-Wackerbarth; M Müller; P Steven; R Birngruber Journal: Klin Monbl Augenheilkd Date: 2009-12-15 Impact factor: 0.700
Authors: Robin Ray; David E Barañano; Jorge A Fortun; Bryan J Schwent; Blaine E Cribbs; Chris S Bergstrom; G Baker Hubbard; Sunil K Srivastava Journal: Ophthalmology Date: 2011-09-09 Impact factor: 12.079
Authors: Justis P Ehlers; Yuankai K Tao; Sina Farsiu; Ramiro Maldonado; Joseph A Izatt; Cynthia A Toth Journal: Retina Date: 2013-01 Impact factor: 4.256
Authors: Justis P Ehlers; Sunil K Srivastava; Daniel Feiler; Amanda I Noonan; Andrew M Rollins; Yuankai K Tao Journal: PLoS One Date: 2014-08-20 Impact factor: 3.240
Authors: Justis P Ehlers; Yasha S Modi; Paula E Pecen; Jeff Goshe; William J Dupps; Aleksandra Rachitskaya; Sumit Sharma; Alex Yuan; Rishi Singh; Peter K Kaiser; Jamie L Reese; Carmen Calabrise; Allison Watts; Sunil K Srivastava Journal: Ophthalmology Date: 2018-03-02 Impact factor: 12.079
Authors: Oscar M Carrasco-Zevallos; Christian Viehland; Brenton Keller; Mark Draelos; Anthony N Kuo; Cynthia A Toth; Joseph A Izatt Journal: Biomed Opt Express Date: 2017-02-21 Impact factor: 3.732
Authors: Mark Draelos; Brenton Keller; Christian Viehland; Oscar M Carrasco-Zevallos; Anthony Kuo; Joseph Izatt Journal: Biomed Opt Express Date: 2018-05-30 Impact factor: 3.732