The Use of Optical Coherence Tomography in Intraoperative Ophthalmic Imaging

Departments of Ophthalmology and Biomedical Engineering, Duke University, Durham, North Carolina, USA.
Ophthalmic Surgery Lasers and Imaging (Impact Factor: 1.32). 07/2011; 42 Suppl(Suppl):S85-94. DOI: 10.3928/15428877-20110627-08
Source: PubMed


Optical coherence tomography (OCT) has transformed diagnostic ophthalmic imaging but until recently has been limited to the clinic setting. The development of spectral-domain OCT (SD-OCT), with its improved speed and resolution, along with the development of a handheld OCT scanner, enabled portable imaging of patients unable to sit in a conventional tabletop scanner. This handheld SD-OCT unit has proven useful in examinations under anesthesia and, more recently, in intraoperative imaging of preoperative and postoperative manipulations. Recently, several groups have pioneered the development of novel OCT modalities, such as microscope-mounted OCT systems. Although still immature, the development of these systems is directed toward real-time imaging of surgical maneuvers in the intraoperative setting. This article reviews intraoperative imaging of the posterior and anterior segment using the handheld SD-OCT and recent advances toward real-time microscope-mounted intrasurgical imaging.

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Available from: Joseph Izatt, Feb 28, 2014
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    • "At the completion of cataract surgery, indirect ophthalmoscopic examination of the posterior pole can help diagnose some of these conditions, and recently, intraoperative optical coherence tomography (OCT) has been used in retinal imaging.15 Though in its early stages, intraoperative OCT can help with the diagnosis of macular pathologies and aid in deciding on appropriate interventions, such as using intravitreal agents. "
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    ABSTRACT: Purpose To determine posterior segment causes of reduced visual acuity after phacoemulsification in eyes with cataract and obscured fundus view. Patients and methods Retrospective review of medical records of patients with cataract, obscured fundus view, and normal B-scan ultrasonography, undergoing phacoemulsification from May 2005 to March 2012 was conducted. Eyes with fundus pathology, previous trauma, surgery, glaucoma, amblyopia, or uveitic cataract were excluded. Ocular comorbid conditions, preoperative visual acuity (VA), intraoperative and early postoperative complications, and final best corrected visual acuity (BCVA) at 1 month were abstracted from the records. Results All 201 eyes of 179 patients studied had a preoperative VA of ≤6/60. Preoperative ocular comorbidity was present in 31 eyes (15.5%). Intraoperative complications occurred in 20 eyes (10%). Postoperative complications developed in 34 eyes (17.0%). One month postoperatively, 175 eyes (87.1%) achieved a BCVA of ≥6/12; whereas 26 eyes (12.9%) achieved a BCVA of ≤6/18. The most common posterior segment causes of reduced VA in the 26 eyes were age-related macular disease in ten eyes (38.5%) and diabetic maculopathy in six eyes (23.1%). Similar fundus pathology was seen preoperatively in the fellow fundus in 10 of the 26 eyes (38.5%). Conclusion One month after phacoemulsification in eyes with cataract and obscured fundus view, age-related macular disease and diabetic maculopathy were the most common posterior segment causes of reduced final BCVA. To avoid postsurgical dissatisfaction, patients with obscured fundus view in their preoperative eye should be counseled, especially if posterior segment pathology exists in their fellow eye.
    Full-text · Article · Nov 2012 · Clinical Ophthalmology
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    ABSTRACT: BACKGROUND: We have recently developed a microscope-integrated spectral-domain optical coherence tomography (MIOCT) device towards intrasurgical cross-sectional imaging of surgical maneuvers. In this report, we explore the capability of MIOCT to acquire real-time video imaging of vitreoretinal surgical maneuvers without post-processing modifications. METHODS: Standard 3-port vitrectomy was performed in human during scheduled surgery as well as in cadaveric porcine eyes. MIOCT imaging of human subjects was performed in healthy normal volunteers and intraoperatively at a normal pause immediately following surgical manipulations, under an Institutional Review Board-approved protocol, with informed consent from all subjects. Video MIOCT imaging of live surgical manipulations was performed in cadaveric porcine eyes by carefully aligning B-scans with instrument orientation and movement. Inverted imaging was performed by lengthening of the reference arm to a position beyond the choroid. RESULTS: Unprocessed MIOCT imaging was successfully obtained in healthy human volunteers and in human patients undergoing surgery, with visualization of post-surgical changes in unprocessed single B-scans. Real-time, unprocessed MIOCT video imaging was successfully obtained in cadaveric porcine eyes during brushing of the retina with the Tano scraper, peeling of superficial retinal tissue with intraocular forceps, and separation of the posterior hyaloid face. Real-time inverted imaging enabled imaging without complex conjugate artifacts. CONCLUSIONS: MIOCT is capable of unprocessed imaging of the macula in human patients undergoing surgery and of unprocessed, real-time, video imaging of surgical maneuvers in model eyes. These capabilities represent an important step towards development of MIOCT for efficient, real-time imaging of manipulations during human surgery.
    No preview · Article · May 2012 · Albrecht von Graæes Archiv für Ophthalmologie
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    ABSTRACT: Optical coherence tomography (OCT) is a noninvasive, noncontact imaging technique capable of producing high-resolution images of the retina and optic nerve. These images provide information that is useful for following the progression and/or resolution of posterior segment disease. Rapid advances in OCT technology allow the acquisition of increasingly detailed images, approaching the original goal of providing in vivo histopathology. Increases in scan acquisition speeds and axial resolution enhance the clinical diagnostic value of this modality. Adapting instrumentation designed for use in human patients for use in animals can be challenging. Each species has a unique set of adjustments that need to be made but it is possible to obtain reproducible, high-quality OCT images in a variety of animals, including rodents, dogs, cats, pigs, and monkeys. Deriving quantitative measurements from OCT instruments is hindered by software algorithm errors in detecting the edges of the distinct retinal layers. These segmentation errors occur in scans of human eyes as well in other species and arise with similar frequency with each of the different OCT instruments. Manual segmentation methods to derive optic nerve head and other structural indices have been developed for several species.
    No preview · Article · Jul 2012 · Veterinary Ophthalmology
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