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Talcott KE, Knapp AN, Amine R, Matar K, Srivastava SK, Rachitskaya A, Sharma S, Singh RP, Yuan A, Reese JL, Ehlers JP. Comparing Three-Dimensional Digitally Enabled Intraoperative OCT With Conventional Microscope-Integrated OCT in Vitreoretinal Surgery: A Post Hoc Analysis of the DISCOVER Study. Ophthalmic Surg Lasers Imaging Retina 2024; 55:270-277. [PMID: 38648428 DOI: 10.3928/23258160-20240206-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND OBJECTIVE This study compared the surgeon experience between conventional microscope-integrated intraoperative optical coherence tomography (iOCT) and digitally enabled microscope-integrated iOCT in vitreoretinal surgery. PATIENTS AND METHODS This is a post hoc case-control analysis of the DISCOVER study. Conventional microscope-integrated iOCT (Rescan 700, Zeiss) was compared with digitally enabled iOCT (Artevo 800, Zeiss). Compared variables included surgical field-based visualization (ie, ocular heads-up display in the conventional group; three-dimensional screen-based visualization in the digital iOCT group) and non-surgical field-based visualization (ie, review on the external two-dimensional monitor). RESULTS A total of 200 patients were included. Surgical field-based visualization of iOCT was significantly higher in the digitally enabled group (P < 0.0001). Required endoillumination level was significantly lower in the digital iOCT group (P < 0.0001). Surgeons reported "significant" back discomfort and headache more frequently when using conventional iOCT (P = 0.003 and P = 0.001, respectively). CONCLUSIONS Digitally enabled iOCT resulted in greater surgical visualization efficiency, appeared to require a lower illumination level, and may provide advantages for ergonomic-related discomfort. [Ophthalmic Surg Lasers Imaging Retina 2024;55:270-277.].
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Truzzi S, Manns F, Parel JM, Ruggeri M. Handheld contact-type OCT and color fundus system for retinal imaging. BIOMEDICAL OPTICS EXPRESS 2024; 15:2681-2696. [PMID: 38633089 PMCID: PMC11019701 DOI: 10.1364/boe.520735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024]
Abstract
We present proof of concept for a handheld contact-type system capable of simultaneous optical coherence tomography (OCT) imaging of the retina and wide-field digital fundus color photography. The study focuses on demonstrating the feasibility of the proposed approach, particularly for eventual use in pediatric patients during examination under anesthesia in the operating room and in the neonatal intensive care unit. Direct contact of the probe with the cornea allows the photographer to maintain a stable position during imaging, reducing motion artifacts in the OCT images. Additionally, it simplifies the alignment process and increases the field of view of the optics. By integrating OCT and fundus imaging into a single device, the proposed compact modular design eliminates the need for separate, space-consuming systems dedicated to each imaging modality.
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Affiliation(s)
- Stefano Truzzi
- Ophthalmic Biophysics Center, Bascom Palmer
Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Engineering “Enzo
Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrice Manns
- Ophthalmic Biophysics Center, Bascom Palmer
Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Jean-Marie Parel
- Ophthalmic Biophysics Center, Bascom Palmer
Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
- Brien Holden Vision Institute, Sydney, NSW, Australia
| | - Marco Ruggeri
- Ophthalmic Biophysics Center, Bascom Palmer
Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
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3
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Dhillon HK, Agarkar S, Vijaya1 L, Bhende M, Baskaran M, Jaichandran VV. Examination under anesthesia: Preferred Practice. Indian J Ophthalmol 2023; 71:3438-3445. [PMID: 37870002 PMCID: PMC10752321 DOI: 10.4103/ijo.ijo_3259_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/18/2023] [Accepted: 06/22/2023] [Indexed: 10/24/2023] Open
Abstract
Pediatric ocular examinations are often a challenge in the outpatient setting due to limited cooperation of the child. Hence an evaluation under anesthesia (EUA) or sedation is important for a holistic ophthalmic examination. It can be combined with short procedures, such as suture removal and corneal scrappings, both for diagnosis and for the management of several ophthalmic disorders. It can also be performed before planning a surgical intervention to record the baseline characters and formulate or refine a surgical plan. Every EUA must be used as a chance to perform a complete ophthalmic examination rather than perform a single task such as recording the intraocular pressure. This article aims to provide a protocol that can be followed for a complete EUA.
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Affiliation(s)
- Hennaav Kaur Dhillon
- Department of Pediatric Ophthalmology and Strabismus, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sumita Agarkar
- Department of Pediatric Ophthalmology and Strabismus, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Lingam Vijaya1
- Department of Pediatric Ophthalmology and Strabismus, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Mani Baskaran
- Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - VV Jaichandran
- Department of Anaesthesia, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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4
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Yusef YN, Petrachkov DV. [Intraoperative optical coherence tomography in vitreoretinal surgery]. Vestn Oftalmol 2023; 139:113-120. [PMID: 37942605 DOI: 10.17116/oftalma2023139051113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
This article reviews literature on the use of intraoperative optical coherence tomography (iOCT) in vitreoretinal surgery, describes the historical aspects of the development of this technology from portable devices to optical coherence tomographs integrated into the surgical microscope, considers the advantages, limitations and disadvantages of this technology, which are now becoming obvious due to the accumulated experience. The review also explores the prospects for the development of iOCT and possible ways to solve its problems. In addition, the review presents and systematizes clinical findings that can be revealed with iOCT in such diseases as rhegmatogenous retinal detachment, complications of proliferative diabetic retinopathy, macular pathology, etc.
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Affiliation(s)
- Yu N Yusef
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - D V Petrachkov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
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5
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Alexopoulos P, Madu C, Wollstein G, Schuman JS. The Development and Clinical Application of Innovative Optical Ophthalmic Imaging Techniques. Front Med (Lausanne) 2022; 9:891369. [PMID: 35847772 PMCID: PMC9279625 DOI: 10.3389/fmed.2022.891369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022] Open
Abstract
The field of ophthalmic imaging has grown substantially over the last years. Massive improvements in image processing and computer hardware have allowed the emergence of multiple imaging techniques of the eye that can transform patient care. The purpose of this review is to describe the most recent advances in eye imaging and explain how new technologies and imaging methods can be utilized in a clinical setting. The introduction of optical coherence tomography (OCT) was a revolution in eye imaging and has since become the standard of care for a plethora of conditions. Its most recent iterations, OCT angiography, and visible light OCT, as well as imaging modalities, such as fluorescent lifetime imaging ophthalmoscopy, would allow a more thorough evaluation of patients and provide additional information on disease processes. Toward that goal, the application of adaptive optics (AO) and full-field scanning to a variety of eye imaging techniques has further allowed the histologic study of single cells in the retina and anterior segment. Toward the goal of remote eye care and more accessible eye imaging, methods such as handheld OCT devices and imaging through smartphones, have emerged. Finally, incorporating artificial intelligence (AI) in eye images has the potential to become a new milestone for eye imaging while also contributing in social aspects of eye care.
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Affiliation(s)
- Palaiologos Alexopoulos
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chisom Madu
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, United States
- Center for Neural Science, College of Arts & Science, New York University, New York, NY, United States
| | - Joel S. Schuman
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, United States
- Center for Neural Science, College of Arts & Science, New York University, New York, NY, United States
- Department of Electrical and Computer Engineering, NYU Tandon School of Engineering, Brooklyn, NY, United States
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6
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Markan A, Gupta N, Tigari B, Singh R, Dogra M. Intraoperative optical coherence tomography (I-OCT) assisted passage of the encircling element during retinal detachment surgery. GMS OPHTHALMOLOGY CASES 2022; 12:Doc10. [PMID: 35465300 PMCID: PMC9006424 DOI: 10.3205/oc000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: To describe the role of microscope integrated optical tomography (Mi-OCT) in passage of the encircling element during retinal detachment surgery. Materials and methods: Mi-OCT was switched on while passing scleral anchoring sutures to secure the encircling element. The depth of the suture tract was seen in real time while the needle was passed through the sclera. The amount of scleral intend achieved was assessed using Mi-OCT at the end of the surgery. Results: The depth of needle tract through the sclera and the amount of scleral indentation achieved while tying the sutures could be successfully analyzed using Mi-OCT. Conclusion: Mi-OCT can be used as an adjunct while training vitreoretinal fellows and trainees in surgical procedures like passage of scleral sutures for anchoring the encircling element.
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Affiliation(s)
- Ashish Markan
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nikita Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Basavaraj Tigari
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India,*To whom correspondence should be addressed: Mohit Dogra, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Vidya Path, Sector 12, 160012 Chandigarh, India, Phone: +91 9814108019, E-mail:
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7
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Rico-Jimenez JJ, Hu D, Tang EM, Oguz I, Tao YK. Real-time OCT image denoising using a self-fusion neural network. BIOMEDICAL OPTICS EXPRESS 2022; 13:1398-1409. [PMID: 35415003 PMCID: PMC8973187 DOI: 10.1364/boe.451029] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/20/2022] [Accepted: 02/06/2022] [Indexed: 06/07/2023]
Abstract
Optical coherence tomography (OCT) has become the gold standard for ophthalmic diagnostic imaging. However, clinical OCT image-quality is highly variable and limited visualization can introduce errors in the quantitative analysis of anatomic and pathologic features-of-interest. Frame-averaging is a standard method for improving image-quality, however, frame-averaging in the presence of bulk-motion can degrade lateral resolution and prolongs total acquisition time. We recently introduced a method called self-fusion, which reduces speckle noise and enhances OCT signal-to-noise ratio (SNR) by using similarity between from adjacent frames and is more robust to motion-artifacts than frame-averaging. However, since self-fusion is based on deformable registration, it is computationally expensive. In this study a convolutional neural network was implemented to offset the computational overhead of self-fusion and perform OCT denoising in real-time. The self-fusion network was pretrained to fuse 3 frames to achieve near video-rate frame-rates. Our results showed a clear gain in peak SNR in the self-fused images over both the raw and frame-averaged OCT B-scans. This approach delivers a fast and robust OCT denoising alternative to frame-averaging without the need for repeated image acquisition. Real-time self-fusion image enhancement will enable improved localization of OCT field-of-view relative to features-of-interest and improved sensitivity for anatomic features of disease.
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Affiliation(s)
- Jose J. Rico-Jimenez
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232, USA
| | - Dewei Hu
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235 USA, USA
| | - Eric M. Tang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232, USA
| | - Ipek Oguz
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235 USA, USA
| | - Yuankai K. Tao
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232, USA
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8
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Benda T, Studený P. INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY -AVAILABLE TECHNOLOGIES AND POSSIBILITIES OF USE. A REVIEW. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2022; 78:277-286. [PMID: 35148610 DOI: 10.31348/2022/2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Optical coherence tomography (OCT) is a non-contact and non-invasive imaging and diagnostic method, that allows the imaging of ocular tissues on transverse sections in extremely high quality of micrometer resolution. The physical principle of OCT is analogous to ultrasound, but it uses infrared radiation instead of acoustic waves. By using a low coherent radiation source, it is possible to achieve a higher resolution. Based on the obtained data, the computer can reconstruct two or three-dimensional images of the examined tissue. In recent years, we have seen a rapid development in ophthalmic surgery, especially in surgical instruments and imaging methods. However, the technology of surgical microscopes does not change significantly and thus becomes a limiting factor in the development of ophthalmic microsurgery. The integration of the OCT into surgical microscopes, so the introduction of the Intraoperative Optical Coherence Tomography (iOCT), opens up further possibilities for displaying/looking at the operating field and adapting surgical techniques to the current situation during the surgery. On the contrary, the disadvantage is the prolongation of the surgery time and thus the theoretical increase in possible complications related to the surgery. iOCT can be used for operations on the anterior and posterior segment of the eye. In anterior segment surgery, it is used mostly in penetrating and lamellar keratoplasty, glaucoma surgery and cataract surgery. In posterior segment surgery, it is used during pars plana vitrectomy. The aim of the article is to provide a comprehensive overview of the current possibilities of using iOCT in eye surgery.
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9
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Ahronovich EZ, Simaan N, Joos KM. A Review of Robotic and OCT-Aided Systems for Vitreoretinal Surgery. Adv Ther 2021; 38:2114-2129. [PMID: 33813718 PMCID: PMC8107166 DOI: 10.1007/s12325-021-01692-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/27/2021] [Indexed: 02/08/2023]
Abstract
The introduction of the intraocular vitrectomy instrument by Machemer et al. has led to remarkable advancements in vitreoretinal surgery enabling the limitations of human physiologic capabilities to be reached. To overcome the barriers of perception, tremor, and dexterity, robotic technologies have been investigated with current advancements nearing the feasibility for clinical use. There are four categories of robotic systems that have emerged through the research: (1) handheld instruments with intrinsic robotic assistance, (2) hand-on-hand robotic systems, (3) teleoperated robotic systems, and (4) magnetic guidance robots. This review covers the improvements and the remaining needs for safe, cost-effective clinical deployment of robotic systems in vitreoretinal surgery.
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Affiliation(s)
- Elan Z. Ahronovich
- Advanced Robotics and Mechanism Applications (ARMA) Laboratory, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235 USA
| | - Nabil Simaan
- Advanced Robotics and Mechanism Applications (ARMA) Laboratory, Department of Mechanical Engineering, Department of Computer Science, Vanderbilt University, Nashville, TN 37235 USA
| | - Karen M. Joos
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232 USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235 USA
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10
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Digital Image Processing and Development of Machine Learning Models for the Discrimination of Corneal Pathology: An Experimental Model. PHOTONICS 2021. [DOI: 10.3390/photonics8040118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Machine learning (ML) has an impressive capacity to learn and analyze a large volume of data. This study aimed to train different algorithms to discriminate between healthy and pathologic corneal images by evaluating digitally processed spectral-domain optical coherence tomography (SD-OCT) corneal images. A set of 22 SD-OCT images belonging to a random set of corneal pathologies was compared to 71 healthy corneas (control group). A binary classification method was applied where three approaches of ML were explored. Once all images were analyzed, representative areas from every digital image were also extracted, processed and analyzed for a statistical feature comparison between healthy and pathologic corneas. The best performance was obtained from transfer learning—support vector machine (TL-SVM) (AUC = 0.94, SPE 88%, SEN 100%) and transfer learning—random forest (TL- RF) method (AUC = 0.92, SPE 84%, SEN 100%), followed by convolutional neural network (CNN) (AUC = 0.84, SPE 77%, SEN 91%) and random forest (AUC = 0.77, SPE 60%, SEN 95%). The highest diagnostic accuracy in classifying corneal images was achieved with the TL-SVM and the TL-RF models. In image classification, CNN was a strong predictor. This pilot experimental study developed a systematic mechanized system to discern pathologic from healthy corneas using a small sample.
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Abstract
Technological advances provide a number of options for glaucoma monitoring outside the office setting, including home-based tonometry and perimetry. This has the potential to revolutionize management of this chronic disease, improve access to care, and enhance patient engagement. Here, we provide an overview of existing technologies for home-based glaucoma monitoring. We also discuss areas for future research and the potential applications of these technologies to telemedicine, which has been brought to the forefront during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Inas F Aboobakar
- Department of Ophthalmology , Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - David S Friedman
- Department of Ophthalmology , Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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12
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Pujari A, Agarwal D, Chawla R, Kumar A, Sharma N. Intraoperative Optical Coherence Tomography Guided Ocular Surgeries: Critical Analysis of Clinical Role and Future Perspectives. Clin Ophthalmol 2020; 14:2427-2440. [PMID: 32904675 PMCID: PMC7457570 DOI: 10.2147/opth.s270708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/07/2020] [Indexed: 11/23/2022] Open
Abstract
Intraoperative imaging of ocular tissues for diagnostic and therapeutic applications has gained immense admiration in recent years. The real time cross-sectional imaging, as well as three and four dimensional reconstruction abilities of intraoperative optical coherence tomography (iOCT), has enhanced our knowledge on many fronts in surgical maneuvers. In this review, we discuss the iOCT discovered constructive knowledge in the cornea, cataract, refractive, glaucoma, pediatric ocular, and various retinal conditions. The practical utility with decision modifying aspects along the specified ocular tissues and with respect to specific ocular entities have been narrated. Moreover, limitations and future directions have also been emphasized to make ophthalmic care more comprehensive in the future.
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Affiliation(s)
- Amar Pujari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Kolenderska SM, Vanholsbeeck F, Kolenderski P. Quantum-inspired detection for spectral domain optical coherence tomography. OPTICS LETTERS 2020; 45:3443-3446. [PMID: 32630867 DOI: 10.1364/ol.393162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
Intensity levels allowed by safety standards (ICNIRP or ANSI) limit the amount of light that can be used in a clinical setting to image highly scattering or absorptive tissues with optical coherence tomography (OCT). To achieve high-sensitivity imaging at low intensity levels, we adapt a detection scheme-which is used in quantum optics for providing information about spectral correlations of photons-into a standard spectral domain OCT system. This detection scheme is based on the concept of dispersive Fourier transformation, where a fiber introduces a wavelength-dependent time delay measured by a single-pixel detector, usually a high-speed photoreceiver. Here, we use a fast superconducting single-photon detector SSPD as a single-pixel detector and obtain images of a glass stack and a slice of onion at the intensity levels of the order of 10 pW. We also provide a formula for a depth-dependent sensitivity falloff in such a detection scheme, which can be treated as a temporal equivalent of diffraction-grating-based spectrometers.
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14
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Zaffino P, Moccia S, De Momi E, Spadea MF. A Review on Advances in Intra-operative Imaging for Surgery and Therapy: Imagining the Operating Room of the Future. Ann Biomed Eng 2020; 48:2171-2191. [PMID: 32601951 DOI: 10.1007/s10439-020-02553-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
Abstract
With the advent of Minimally Invasive Surgery (MIS), intra-operative imaging has become crucial for surgery and therapy guidance, allowing to partially compensate for the lack of information typical of MIS. This paper reviews the advancements in both classical (i.e. ultrasounds, X-ray, optical coherence tomography and magnetic resonance imaging) and more recent (i.e. multispectral, photoacoustic and Raman imaging) intra-operative imaging modalities. Each imaging modality was analyzed, focusing on benefits and disadvantages in terms of compatibility with the operating room, costs, acquisition time and image characteristics. Tables are included to summarize this information. New generation of hybrid surgical room and algorithms for real time/in room image processing were also investigated. Each imaging modality has its own (site- and procedure-specific) peculiarities in terms of spatial and temporal resolution, field of view and contrasted tissues. Besides the benefits that each technique offers for guidance, considerations about operators and patient risk, costs, and extra time required for surgical procedures have to be considered. The current trend is to equip surgical rooms with multimodal imaging systems, so as to integrate multiple information for real-time data extraction and computer-assisted processing. The future of surgery is to enhance surgeons eye to minimize intra- and after-surgery adverse events and provide surgeons with all possible support to objectify and optimize the care-delivery process.
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Affiliation(s)
- Paolo Zaffino
- Department of Experimental and Clinical Medicine, Universitá della Magna Graecia, Catanzaro, Italy
| | - Sara Moccia
- Department of Information Engineering (DII), Universitá Politecnica delle Marche, via Brecce Bianche, 12, 60131, Ancona, AN, Italy.
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milano, MI, Italy
| | - Maria Francesca Spadea
- Department of Experimental and Clinical Medicine, Universitá della Magna Graecia, Catanzaro, Italy
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15
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Lang SJ, Heinzelmann S, Böhringer D, Reinhard T, Maier P. Indications for intraoperative anterior segment optical coherence tomography in corneal surgery. Int Ophthalmol 2020; 40:2617-2625. [PMID: 32506295 PMCID: PMC7502442 DOI: 10.1007/s10792-020-01442-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/23/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Recently, intraoperative optical coherence tomography (iOCT) has evolved in the field of ophthalmic surgery. So far, the use of iOCT was mainly focused to lamellar keratoplasty, especially deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). The aim of this study was to report our experiences with iOCT to introduce new possibilities of this application. METHODS We used iOCT in 18 patients who underwent the following surgeries: DALK, DMEK, penetrating keratoplasty, autologous limbal transplantation, transscleral suture fixation of a posterior chamber lens, pannus removal on corneal surface and newborn investigation in Peters' anomaly. We obtained qualitative video data for all procedures. RESULTS With the iOCT, the cannula placement during DALK preparation of the recipient cornea and bubble formation could be visualized to improve the success rate of the big bubble injection. In DMEK, the iOCT enables the visualization of Descemet's membrane removal in the recipient and graft orientation as well as better control of graft attachment. The iOCT enables intraoperative visualization of the graft-host interface during penetrating keratoplasty. During autologous limbal transplantation, transscleral suture fixation of a posterior chamber lens and removal of corneal surface pannus the iOCT is capable of showing the thickness of lamellar preparations to avoid penetrations and to save healthy recipient's tissue. CONCLUSION The iOCT is a helpful device for intraoperative anterior segment imaging not only for DALK and DMEK. It is also beneficial in penetrating keratoplasty and every other form of lamellar preparation during corneoscleral surgery.
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Affiliation(s)
- Stefan J Lang
- Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Sonja Heinzelmann
- Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Daniel Böhringer
- Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Thomas Reinhard
- Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Philip Maier
- Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany
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Fang W, Li Q, Fan J, Tang N, Yu J, Xu H, Zong Y, Jiang C, Shi G, Sun X. Microscope-integrated Intraoperative Optical Coherence Tomography for Anterior Segment Surgical Maneuvers. Transl Vis Sci Technol 2020; 9:18. [PMID: 32832225 PMCID: PMC7414702 DOI: 10.1167/tvst.9.7.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/21/2020] [Indexed: 01/26/2023] Open
Abstract
Purpose To evaluate the potential value of microscope-integrated optical coherence tomography (MI-OCT) in anterior segment surgical maneuvers. Methods Twenty-four ophthalmology residents, who were randomly and evenly divided into two groups, performed four anterior segment surgical maneuvers (corneal tunnel, scleral tunnel, simple corneal suture, and corneal laceration repair) on porcine eyes with (group B) or without (group A) real-time MI-OCT feedback. All residents performed the maneuvers again without MI-OCT. Results Compared with group A, group B (with MI-OCT) showed better accuracy in the length/depth of the corneal tunnel and the length of the scleral tunnel. However, both groups showed similar performances in the depth of both the simple corneal suture and the corneal laceration suture. When both groups performed the maneuvers again without MI-OCT, group B still showed better results than group A for the length of both the corneal and scleral tunnels. Conclusions Primary results suggest that real-time MI-OCT images are valuable for some anterior segment surgical maneuvers and could be helpful in surgical training. Translational Relevance MI-OCT systems can be valuable in improving accuracy and decision making during anterior segment surgery and will be useful in surgical training.
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Affiliation(s)
- Wangyi Fang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, People's Republic of China
| | - Qingchen Li
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, People's Republic of China
| | - Jinyu Fan
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu Province, China
| | - Ning Tang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu Province, China
| | - Jian Yu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, People's Republic of China
| | - Huan Xu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, People's Republic of China
| | - Yuan Zong
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, People's Republic of China
| | - Chunhui Jiang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, People's Republic of China
| | - Guohua Shi
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu Province, China
| | - Xinghuai Sun
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, People's Republic of China
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17
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Ji X, Wright T, VandenHoven C, MacKeen L, McFarlane M, Liu H, Dupuis A, Westall C. Reliability of Handheld Optical Coherence Tomography in Children Younger Than Three Years of Age Undergoing Vigabatrin Treatment for Childhood Epilepsy. Transl Vis Sci Technol 2020; 9:9. [PMID: 32704429 PMCID: PMC7347507 DOI: 10.1167/tvst.9.3.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose Vigabatrin-associated retinal toxicity manifests as reduction in the clinical electroretinogram and retinal nerve fiber layer (RNFL) thinning. This observational investigation of RNFL thickness in young vigabatrin-treated children was to identify intravisit and intervisit reliabilities of peripapillary RNFL thickness measurements performed with Envisu (optical coherence tomography) OCT. Secondarily, a longitudinal assessment investigated the presence and extent of RNFL thinning. Methods We measured the handheld OCT in sedated children to evaluate the RNFL thickness using segmentation software. Intraclass correlation coefficient (ICC) statistics identified intravisit and intervisit reliabilities for RNFL thickness. Results Twenty-nine children (10.1 ± 6.0 months old) underwent handheld optical coherence tomography (OCT). Fourteen of these completed follow-up assessments. Intravisit reliability was good for the right eye (ICCs = 0.82-0.98) and the left eye (ICCs = 0.75-0.89) for each of the 4 retinal quadrants. Inter-visit ICCs for each of the 4 retinal quadrants were good (ICC = 0.82-0.98). There was no consistent change in RNFL thickness longitudinally. Conclusions In this pediatric cohort, RNFL thickness measures using handheld OCT provided good reliability within a single visit and between consecutive visits supporting its use as an adjunctive tool in the clinical setting. Further long-term follow-up is required to understand RNFL thickness changes in this specific population and its association with vigabatrin toxicity. Translational Relevance The findings of good reliability and clinical feasibility would provide an opportunity for the handheld OCT to monitor reliably for vigabatrin-associated retinal toxicity in children who often show noncompliance to traditional testing approaches.
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Affiliation(s)
- Xiang Ji
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Tom Wright
- Kensington Eye Institute, Toronto, ON, Canada
| | - Cynthia VandenHoven
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leslie MacKeen
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle McFarlane
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Henry Liu
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Annie Dupuis
- Clinical Research Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - Carol Westall
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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Abstract
Intraoperative OCT (iOCT) is an emerging modality capable of displaying real-time OCT images to the surgeon during surgery. The use of iOCT during vitreoretinal surgery improves our understanding of the tissue alterations that occur during surgical manipulations, which may impact surgical decision-making. We review the current iOCT modalities and clinical applications of iOCT.
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Affiliation(s)
- Cindy Ung
- a Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
| | - John B Miller
- a Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
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HOLE-DOOR SIGN: A Novel Intraoperative Optical Coherence Tomography Feature Predicting Macular Hole Closure. Retina 2019; 38:2045-2050. [PMID: 28796146 DOI: 10.1097/iae.0000000000001791] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a novel intraoperative finding during pars plana vitrectomy for macular hole using operating microscope-integrated spectral domain optical coherence tomography that predicts the closure of macular hole. METHODS Twenty-five eyes of 25 patients with macular hole, who underwent 25-gauge pars plana vitrectomy over a period of 16 months at a tertiary eye care center by a single surgeon, were recruited in this retrospective interventional study. All eyes were assessed with intraoperative spectral domain optical coherence tomography before and after internal limiting membrane peeling. The patients were assessed in terms of best-corrected visual acuity, preoperative minimal hole diameter, and type of hole closure. RESULTS After the internal limiting membrane was peeled, vertical pillars of tissue were seen at the edges of hole projecting into the vitreous cavity. This appearance was similar to that of an open door over the macular hole and was termed "hole-door sign." Hole-door sign was seen in 15 of 25 eyes (60%). All the eyes with hole-door sign had Type-1 closure of macular hole (100%), whereas only 6 of 10 eyes (60%) without hole-door sign had Type-1 closure of the macular hole. CONCLUSION Hole-door sign is a novel intraoperative finding that predicts postoperative Type-1 closure of macular hole. This may add to the utility of intraoperative optical coherence tomography in clinical practice.
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20
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THE INTEGRATIVE SURGICAL THEATER: Combining Intraoperative Optical Coherence Tomography and 3D Digital Visualization for Vitreoretinal Surgery in the DISCOVER Study. Retina 2018; 38 Suppl 1:S88-S96. [PMID: 29256988 DOI: 10.1097/iae.0000000000001999] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the feasibility of integrating intraoperative optical coherence tomography (OCT) with a digital visualization platform for vitreoretinal surgery. METHODS The DISCOVER study is a prospective study examining microscope-integrated intraoperative OCT across multiple prototypes and platforms. For this assessment, a microscope-integrated OCT platform was combined with a three-dimensional (3D) surgical visualization system to allow for digital display of the OCT data stream on the large immersive display. Intraoperative OCT scans were obtained at various surgical milestones that were directly overlaid to the surgical view in a 55-inch passive 3D 4K high-definition display. Surgeon feedback was obtained related to system performance and integration into the surgical procedures through a prespecified surgeon questionnaire. RESULTS Seven eyes of seven subjects were identified. Clinical diagnosis included epiretinal membrane (n = 3), macular hole (2), symptomatic vitreous opacity (1), and proliferative vitreoretinopathy (1). Optical coherence tomography images were successfully obtained and displayed on the 4K screen in all cases. Intraoperative OCT images facilitated identification of subtle retinal alterations. Surgeons reported that the 4K screen seemed to provide improved visualization of the OCT data stream compared with the semitransparent ocular view. Surgeons were able to examine the OCT data on the 4K screen without reverting to the external display system of the microscope. The system provided a uniform surgical visualization experience for both the surgeon and the assistant. In addition, the digital platform allowed all surgical personnel to simultaneously view both the OCT and the surgical field. All eyes underwent uneventful vitrectomy without reverting to the conventional microscope. No intraoperative adverse events occurred. CONCLUSION Integration of OCT into the digital visualization system may enable unique opportunities for surgeon feedback of intraoperative diagnostics. The overlay of the OCT data onto the 4K monitor seemed to provide excellent visualization of OCT details. Further research is needed to compare the conventional microscope-based approach to the digital 3D screen approach in regards to intraoperative OCT.
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21
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Khan M, Srivastava SK, Reese JL, Shwani Z, Ehlers JP. Intraoperative OCT-assisted Surgery for Proliferative Diabetic Retinopathy in the DISCOVER Study. Ophthalmol Retina 2018; 2:411-417. [PMID: 30035245 DOI: 10.1016/j.oret.2017.08.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose To delineate the feasibility and role of intraoperative optical coherence tomography (iOCT) in surgical decision-making during vitreoretinal surgical interventions for proliferative diabetic retinopathy (PDR). Design Prospective, single-site, multi-surgeon consecutive case series. Participants Patients enrolled in the DISCOVER study who underwent vitreoretinal surgery for sequelae of PDR. Methods Subjects were identified from the first 2 years of the DISCOVER study that underwent vitreoretinal surgery for complications of PDR. Intraoperative imaging with a microscope-integrated iOCT system was performed at surgical milestones as determined by the surgeon. Data collected included clinical characteristics, image features, and survey-based surgeon feedback. Main Outcome Measures Main outcomes were 1) the percentage of cases with successful acquisition of iOCT (feasibility) and 2) the percentage of cases in which iOCT altered surgical decision-making (utility). Results Eighty-one eyes with PDR underwent vitreoretinal surgery in the DISCOVER study. Successful iOCT imaging was obtained for 80 of 81 eyes (98.8%). Of these, 36 (44.4%) were female and 44 (54.3%) were male. The surgeon preferred real-time feedback in 47 cases (58.6%), static review in 29 cases (36.3%), and was indeterminate in 4 cases (5%). Surgeons reported that in 2 cases (2.5%) the iOCT interfered with the surgery (e.g., microscope malfunction). In 41 of the 81 cases (50.6%), surgeons reported that iOCT provided valuable information (e.g., identification of dissection planes, identification of retinal hole). In addition, the iOCT data provided information that specifically altered the surgeon's decision making (e.g., determination of peel completion, choice of tamponade) in 21 of 81 cases (26%). No adverse events were attributed to the iOCT system. Conclusions The results suggest that iOCT is feasible during complex vitreoretinal surgeries in patients with PDR using a microscope-integrated OCT platform. Utilizing intraoperative OCT, appears to frequently offer key information that may impact surgical decision-making and potentially patient outcomes.
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Affiliation(s)
- Mehnaz Khan
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
| | - Sunil K Srivastava
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
| | - Jamie L Reese
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
| | - Zryan Shwani
- Case Western University School of Medicine, Cleveland, OH
| | - Justis P Ehlers
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
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22
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Uchida A, Srivastava SK, Ehlers JP. Update on the Intraoperative OCT: Where Do We Stand? CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0160-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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23
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Li J, Quirk BC, Noble PB, Kirk RW, Sampson DD, McLaughlin RA. Flexible needle with integrated optical coherence tomography probe for imaging during transbronchial tissue aspiration. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-5. [PMID: 29022301 DOI: 10.1117/1.jbo.22.10.106002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/08/2017] [Indexed: 06/07/2023]
Abstract
Transbronchial needle aspiration (TBNA) of small lesions or lymph nodes in the lung may result in nondiagnostic tissue samples. We demonstrate the integration of an optical coherence tomography (OCT) probe into a 19-gauge flexible needle for lung tissue aspiration. This probe allows simultaneous visualization and aspiration of the tissue. By eliminating the need for insertion and withdrawal of a separate imaging probe, this integrated design minimizes the risk of dislodging the needle from the lesion prior to aspiration and may facilitate more accurate placement of the needle. Results from in situ imaging in a sheep lung show clear distinction between solid tissue and two typical constituents of nondiagnostic samples (adipose and lung parenchyma). Clinical translation of this OCT-guided aspiration needle holds promise for improving the diagnostic yield of TBNA.
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Affiliation(s)
- Jiawen Li
- University of Adelaide, Adelaide Medical School, Australian Research Council Centre of Excellence fo, Australia
- University of Adelaide, Institute for Photonics and Advanced Sensing, Adelaide, South Australia, Australia
| | - Bryden C Quirk
- University of Adelaide, Adelaide Medical School, Australian Research Council Centre of Excellence fo, Australia
- University of Adelaide, Institute for Photonics and Advanced Sensing, Adelaide, South Australia, Australia
| | - Peter B Noble
- University of Western Australia, School of Human Sciences, Perth, Western Australia, Australia
- University of Western Australia, School of Paediatrics and Child Health, Centre for Neonatal Researc, Australia
| | - Rodney W Kirk
- University of Adelaide, Adelaide Medical School, Australian Research Council Centre of Excellence fo, Australia
- University of Adelaide, Institute for Photonics and Advanced Sensing, Adelaide, South Australia, Australia
| | - David D Sampson
- University of Western Australia, School of Electrical, Electronic and Computer Engineering, Optical+, Australia
- University of Western Australia, Centre for Microscopy, Characterisation and Analysis, Perth, Wester, Australia
| | - Robert A McLaughlin
- University of Adelaide, Adelaide Medical School, Australian Research Council Centre of Excellence fo, Australia
- University of Adelaide, Institute for Photonics and Advanced Sensing, Adelaide, South Australia, Australia
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24
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Ehlers JP, Uchida A, Srivastava SK. Intraoperative optical coherence tomography-compatible surgical instruments for real-time image-guided ophthalmic surgery. Br J Ophthalmol 2017; 101:1306-1308. [PMID: 28729372 DOI: 10.1136/bjophthalmol-2017-310530] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/22/2017] [Accepted: 06/16/2017] [Indexed: 11/03/2022]
Abstract
Intraoperative optical coherence tomography (OCT) is a potentially transformational technology that is now commercially available to ophthalmic surgeons. Currently, the use of the technology is primarily limited to a 'stop and image' approach due to the lack of OCT compatibility with surgical instrumentation. In this report, we describe multiple OCT-compatible surgical instruments that were developed for various surgical needs, based on previous evaluation of potential surgical materials for optical features and physical properties. OCT-compatible instrumentation included two membrane scrapers, a surgical pick and vitreoretinal forceps. Imaging during in vitro and ex vivo-simulated surgical procedures demonstrated excellent visualisation of the instrument tip and of the tissue-instrument interaction. These OCT-compatible instruments may be a key component to the feasibility of real-time image-guided surgery with intraoperative OCT.
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Affiliation(s)
- Justis P Ehlers
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Atsuro Uchida
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sunil K Srivastava
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
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25
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Runkle A, Srivastava SK, Ehlers JP. Microscope-Integrated OCT Feasibility and Utility With the EnFocus System in the DISCOVER Study. Ophthalmic Surg Lasers Imaging Retina 2017; 48:216-222. [PMID: 28297033 DOI: 10.3928/23258160-20170301-04] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 01/11/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the feasibility and utility of a novel microscope-integrated intraoperative optical coherence tomography (OCT) system. PATIENTS AND METHODS The DISCOVER study is an investigational device study evaluating microscope-integrated intraoperative OCT systems for ophthalmic surgery. This report focuses on subjects imaged with the EnFocus prototype system (Leica Microsystems/Bioptigen, Morrisville, NC). OCT was performed at surgeon-directed milestones. Surgeons completed a questionnaire after each case to evaluate the impact of OCT on intraoperative management. RESULTS Fifty eyes underwent imaging with the EnFocus system. Successful imaging was obtained in 46 of 50 eyes (92%). In eight cases (16%), surgical management was changed based on intraoperative OCT findings. In membrane peeling procedures, intraoperative OCT findings were discordant from the surgeon's initial impression in seven of 20 cases (35%). CONCLUSION This study demonstrates the feasibility of microscope-integrated intraoperative OCT using the Bioptigen EnFocus system. Intraoperative OCT may provide surgeons with additional information that may influence surgical decision-making. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:216-222.].
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Carrasco-Zevallos OM, Keller B, Viehland C, Shen L, Seider MI, Izatt JA, Toth CA. Optical Coherence Tomography for Retinal Surgery: Perioperative Analysis to Real-Time Four-Dimensional Image-Guided Surgery. Invest Ophthalmol Vis Sci 2017; 57:OCT37-50. [PMID: 27409495 PMCID: PMC4968921 DOI: 10.1167/iovs.16-19277] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Magnification of the surgical field using the operating microscope facilitated profound innovations in retinal surgery in the 1970s, such as pars plana vitrectomy. Although surgical instrumentation and illumination techniques are continually developing, the operating microscope for vitreoretinal procedures has remained essentially unchanged and currently limits the surgeon's depth perception and assessment of subtle microanatomy. Optical coherence tomography (OCT) has revolutionized clinical management of retinal pathology, and its introduction into the operating suite may have a similar impact on surgical visualization and treatment. In this article, we review the evolution of OCT for retinal surgery, from perioperative analysis to live volumetric (four-dimensional, 4D) image-guided surgery. We begin by briefly addressing the benefits and limitations of the operating microscope, the progression of OCT technology, and OCT applications in clinical/perioperative retinal imaging. Next, we review intraoperative OCT (iOCT) applications using handheld probes during surgical pauses, two-dimensional (2D) microscope-integrated OCT (MIOCT) of live surgery, and volumetric MIOCT of live surgery. The iOCT discussion focuses on technological advancements, applications during human retinal surgery, translational difficulties and limitations, and future directions.
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Affiliation(s)
| | - Brenton Keller
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States
| | - Christian Viehland
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States
| | - Liangbo Shen
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States
| | - Michael I Seider
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States
| | - Joseph A Izatt
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States 2Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States
| | - Cynthia A Toth
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States 2Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States
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Wang S, Garcia MD, Lopez AL, Overbeek PA, Larin KV, Larina IV. Dynamic imaging and quantitative analysis of cranial neural tube closure in the mouse embryo using optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2017; 8:407-419. [PMID: 28101427 PMCID: PMC5231309 DOI: 10.1364/boe.8.000407] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/14/2016] [Indexed: 05/18/2023]
Abstract
Neural tube closure is a critical feature of central nervous system morphogenesis during embryonic development. Failure of this process leads to neural tube defects, one of the most common forms of human congenital defects. Although molecular and genetic studies in model organisms have provided insights into the genes and proteins that are required for normal neural tube development, complications associated with live imaging of neural tube closure in mammals limit efficient morphological analyses. Here, we report the use of optical coherence tomography (OCT) for dynamic imaging and quantitative assessment of cranial neural tube closure in live mouse embryos in culture. Through time-lapse imaging, we captured two neural tube closure mechanisms in different cranial regions, zipper-like closure of the hindbrain region and button-like closure of the midbrain region. We also used OCT imaging for phenotypic characterization of a neural tube defect in a mouse mutant. These results suggest that the described approach is a useful tool for live dynamic analysis of normal neural tube closure and neural tube defects in the mouse model.
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Affiliation(s)
- Shang Wang
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
- Equal Contribution
| | - Monica D. Garcia
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
- Equal Contribution
| | - Andrew L. Lopez
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Paul A. Overbeek
- Department of Molecular & Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Kirill V. Larin
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
- Interdisciplinary Laboratory of Biophotonics, Tomsk State University, Tomsk, Russia
- Department of Biomedical Engineering, University of Houston, 3605 Cullen Blvd., Houston, TX 77204, USA
| | - Irina V. Larina
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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Jayadev C, Dabir S, Vinekar A, Shah U, Vaid T, Yadav NK. Microscope-integrated optical coherence tomography: A new surgical tool in vitreoretinal surgery. Indian J Ophthalmol 2016; 63:399-403. [PMID: 26139800 PMCID: PMC4501135 DOI: 10.4103/0301-4738.159865] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Optical coherence tomography (OCT) has revolutionized imaging of ocular structures and various disease conditions. Though it has been used in the clinic for some decades, the OCT has only recently found its way into the operating theater. Early attempts at intraoperative OCT, hand-held and microscope mounted, have already improved our understanding of the surgical pathology and the role it might play in surgical decision-making. The microscope-integrated OCT now allows seamless, high-resolution, real-time imaging of surgical maneuvers from the incision to wound closure. Visualization of instruments and intraoperative tissue manipulation are possible with this in vivo modality and, therefore, help improve the outcome of surgery. In this article, we describe the advantages it offers during various vitreoretinal procedures.
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Affiliation(s)
- Chaitra Jayadev
- Department of Vitreo-Retina and Pediatric Retina, Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bengaluru, Karnataka, India
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Utility of Anterior Segment Optical Coherence Tomography in the Management of Corneal Transplantation. CURRENT OPHTHALMOLOGY REPORTS 2016. [DOI: 10.1007/s40135-016-0114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Abstract
PURPOSE OF REVIEW To explore the clinical utility of intraoperative optical coherence tomography (iOCT) for the management of vitreoretinal conditions. RECENT FINDINGS The role of iOCT in guiding surgical decision-making and surgical manipulations during vitreoretinal procedures has been evaluated by multiple studies. This imaging modality is emerging as a valuable asset during procedures for vitreoretinal interface disorders, retinal detachments, submacular surgeries and therapeutics, and in pediatric conditions such as retinopathy of prematurity. iOCT allows the surgeon to assess completion of surgical goals and to directly monitor the architectural impact of instrument-tissue interactions that may correlate with eventual prognosis. The technology has gone through numerous iterations with the eventual goal being the development of a user-friendly, efficient, and integrated system that provides surgeons with 'real-time' feedback during ophthalmic surgeries to allow for a comprehensive image-assisted vitreoretinal surgery platform. SUMMARY The role of iOCT in ophthalmic surgery has been evolving with the help of ongoing research to define its utility in the operating room and to develop integrative technologies. Advancements in OCT-friendly surgical instrumentation and in integrative capabilities of this technology may help achieve more widespread adoption of this technology in the vitreoretinal surgical theater. Although the evidence appears clear that this technology impacts surgical decision-making, additional research is needed. However, further research is needed to determine the influence of this technology on overall patient outcomes.
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Branchini LA, Gurley K, Duker JS, Reichel E. Use of Handheld Intraoperative Spectral-Domain Optical Coherence Tomography in a Variety of Vitreoretinal Diseases. Ophthalmic Surg Lasers Imaging Retina 2016; 47:49-54. [PMID: 26731209 DOI: 10.3928/23258160-20151214-07] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/06/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The use of intraoperative optical coherence tomography (iOCT) has been described with a variety of imaging devices and techniques. The purpose of this investigation is to examine the role of iVue (Optovue, Fremont, CA), a commercially available, handheld spectral-domain iOCT system, in vitreoretinal surgery. PATIENTS AND METHODS For this retrospective, observational case series, patients who underwent a vitreoretinal surgical procedure and were imaged with the iVue were identified. Images were qualitatively assessed. RESULTS Five cases were identified, including an examination under anesthesia, epiretinal membrane, macular hole, retinal detachment, and non-clearing vitreous hemorrhage in the setting of proliferative diabetic retinopathy. CONCLUSION Clinically useful images were obtained in all cases, though it was difficult to center the scan on the area of interest in the retina. Further work is necessary to improve system design and investigate the ways in which iOCT can aid in vitreoretinal surgery.
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INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY DURING VITREORETINAL SURGERY FOR DENSE VITREOUS HEMORRHAGE IN THE PIONEER STUDY. Retina 2016; 35:2537-42. [PMID: 26035403 DOI: 10.1097/iae.0000000000000660] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To evaluate the feasibility and utility of intraoperative optical coherence tomography (OCT) during pars plana vitrectomy surgery for dense vitreous hemorrhage. METHODS 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. RESULTS 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. CONCLUSION 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.
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Abstract
Over the recent years, retina specialists have enjoyed significant improvements in the surgical management of proliferative diabetic retinopathy including improved preoperative planning, vitreoretinal instrumentation and new surgical maneuvers. In this review, we present new tips and tricks such as preoperative pharmacotherapy approaches including pegaptanib injection and biodegradable dexamethasone implantation, bimanual vitrectomy techniques and the concept of mixing small gauges as well as valved cannulas and intraoperative optical coherence tomography. With advanced surgical planning and sophisticated operative maneuvers tailored to the individual patient, excellent outcomes can be achieved even in severe cases of diabetic tractional detachment.
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Affiliation(s)
- Patrick Oellers
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Tamer H Mahmoud
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
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INTRASURGICAL MICROSCOPE-INTEGRATED SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY-ASSISTED MEMBRANE PEELING. Retina 2016; 35:2100-6. [PMID: 25978733 DOI: 10.1097/iae.0000000000000596] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate microscope-integrated intrasurgical spectral domain optical coherence tomography during macular surgery in a prospective monocenter study. METHODS Before pars plana vitrectomy and before, during, and after membrane peeling, 512 × 128 macular cube scans were performed using a Carl Zeiss Meditec Cirrus high-definition OCT system adapted to the optical pathway of a Zeiss OPMI VISU 200 surgical microscope and compared with retinal staining. RESULTS The study included 51 patients with epiretinal membranes, with 8 of those having additional lamellar macular holes, 11 patients with vitreomacular traction, and 8 patients with full-thickness macular holes. Intraoperative spectral domain optical coherence tomography allowed performing membrane peeling without using retinal dyes in 40% of cases (28 of 70 patients). No residual membranes were found in 94.3% of patients (66 of 70 patients) in intrasurgical spectral domain optical coherence tomography and subsequent (re)staining. In patients with vitreomacular traction, intrasurgical spectral domain optical coherence tomography scans facilitated decisions on the need for an intraocular tamponade after membrane peeling. CONCLUSION Intraoperative spectral domain optical coherence tomography was comparable with retinal dyes in confirming success after membrane peeling. However, the visualization of flat membranes was better after staining.
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Shen L, Carrasco-Zevallos O, Keller B, Viehland C, Waterman G, Hahn PS, Kuo AN, Toth CA, Izatt JA. Novel microscope-integrated stereoscopic heads-up display for intrasurgical optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2016; 7:1711-26. [PMID: 27231616 PMCID: PMC4871076 DOI: 10.1364/boe.7.001711] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 05/22/2023]
Abstract
Intra-operative optical coherence tomography (OCT) requires a display technology which allows surgeons to visualize OCT data without disrupting surgery. Previous research and commercial intrasurgical OCT systems have integrated heads-up display (HUD) systems into surgical microscopes to provide monoscopic viewing of OCT data through one microscope ocular. To take full advantage of our previously reported real-time volumetric microscope-integrated OCT (4D MIOCT) system, we describe a stereoscopic HUD which projects a stereo pair of OCT volume renderings into both oculars simultaneously. The stereoscopic HUD uses a novel optical design employing spatial multiplexing to project dual OCT volume renderings utilizing a single micro-display. The optical performance of the surgical microscope with the HUD was quantitatively characterized and the addition of the HUD was found not to substantially effect the resolution, field of view, or pincushion distortion of the operating microscope. In a pilot depth perception subject study, five ophthalmic surgeons completed a pre-set dexterity task with 50.0% (SD = 37.3%) higher success rate and in 35.0% (SD = 24.8%) less time on average with stereoscopic OCT vision compared to monoscopic OCT vision. Preliminary experience using the HUD in 40 vitreo-retinal human surgeries by five ophthalmic surgeons is reported, in which all surgeons reported that the HUD did not alter their normal view of surgery and that live surgical maneuvers were readily visible in displayed stereoscopic OCT volumes.
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Affiliation(s)
- Liangbo Shen
- Duke University, Dept. of Biomedical Engineering, Durham, NC, 27708, USA
| | | | - Brenton Keller
- Duke University, Dept. of Biomedical Engineering, Durham, NC, 27708, USA
| | - Christian Viehland
- Duke University, Dept. of Biomedical Engineering, Durham, NC, 27708, USA
| | - Gar Waterman
- Duke University, Dept. of Biomedical Engineering, Durham, NC, 27708, USA
| | - Paul S. Hahn
- Duke University Medical Center, Dept. of Ophthalmology, Durham, NC, 27710, USA
| | - Anthony N. Kuo
- Duke University Medical Center, Dept. of Ophthalmology, Durham, NC, 27710, USA
| | - Cynthia A. Toth
- Duke University, Dept. of Biomedical Engineering, Durham, NC, 27708, USA
- Duke University Medical Center, Dept. of Ophthalmology, Durham, NC, 27710, USA
| | - Joseph A. Izatt
- Duke University, Dept. of Biomedical Engineering, Durham, NC, 27708, USA
- Duke University Medical Center, Dept. of Ophthalmology, Durham, NC, 27710, USA
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Viehland C, Keller B, Carrasco-Zevallos OM, Nankivil D, Shen L, Mangalesh S, Viet DT, Kuo AN, Toth CA, Izatt JA. Enhanced volumetric visualization for real time 4D intraoperative ophthalmic swept-source OCT. BIOMEDICAL OPTICS EXPRESS 2016; 7:1815-29. [PMID: 27231623 PMCID: PMC4871083 DOI: 10.1364/boe.7.001815] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 05/22/2023]
Abstract
Current-generation software for rendering volumetric OCT data sets based on ray casting results in volume visualizations with indistinct tissue features and sub-optimal depth perception. Recent developments in hand-held and microscope-integrated intrasurgical OCT designed for real-time volumetric imaging motivate development of rendering algorithms which are both visually appealing and fast enough to support real time rendering, potentially from multiple viewpoints for stereoscopic visualization. We report on an enhanced, real time, integrated volumetric rendering pipeline which incorporates high performance volumetric median and Gaussian filtering, boundary and feature enhancement, depth encoding, and lighting into a ray casting volume rendering model. We demonstrate this improved model implemented on graphics processing unit (GPU) hardware for real-time volumetric rendering of OCT data during tissue phantom and live human surgical imaging. We show that this rendering produces enhanced 3D visualizations of pathology and intraoperative maneuvers compared to standard ray casting.
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Affiliation(s)
- Christian Viehland
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Brenton Keller
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | | | - Derek Nankivil
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Liangbo Shen
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Shwetha Mangalesh
- Deparment of Ophthalmology, Duke University Medical Center, Durham NC 27710, USA
| | - Du Tran Viet
- Deparment of Ophthalmology, Duke University Medical Center, Durham NC 27710, USA
| | - Anthony N. Kuo
- Deparment of Ophthalmology, Duke University Medical Center, Durham NC 27710, USA
| | - Cynthia A. Toth
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Deparment of Ophthalmology, Duke University Medical Center, Durham NC 27710, USA
| | - Joseph A. Izatt
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Deparment of Ophthalmology, Duke University Medical Center, Durham NC 27710, USA
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Ehlers JP. Intraoperative optical coherence tomography: past, present, and future. Eye (Lond) 2015; 30:193-201. [PMID: 26681147 DOI: 10.1038/eye.2015.255] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 01/14/2023] Open
Abstract
To provide an overview of the current state of intraoperative optical coherence tomography (OCT). Literature review of studies pertaining to intraoperative OCT examining both the technology aspects of the imaging platform and the current evidence for patient care. Over the last several years, there have been significant advances in integrative technology for intraoperative OCT. This has resulted in the development of multiple microscope-integrated systems and a rapidly expanding field of image-guided surgical care. Multiple studies have demonstrated the potential role for intraoperative OCT in facilitating surgeon understanding of the surgical environment, tissue configuration, and overall changes to anatomy. In fact, the PIONEER and DISCOVER studies, both demonstrated a potential significant percentage of cases that intraoperative OCT alters surgical decision-making in both anterior and posterior segment surgery. Current areas of exploration and development include OCT-compatible instrumentation, automated tracking, intraoperative OCT software platforms, and surgeon feedback/visualization platforms. Intraoperative OCT is an emerging technology that holds promise for enhancing the surgical care of both anterior segment and posterior segment conditions. Hurdles remain for adoption and widespread utilization, including cost, optimized feedback platforms, and more definitive value for individualized surgical care with image guidance.
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Affiliation(s)
- J P Ehlers
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
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Toygar O, Riemann CD. Intraoperative optical coherence tomography in macula involving rhegmatogenous retinal detachment repair with pars plana vitrectomy and perfluoron. Eye (Lond) 2015; 30:23-30. [PMID: 26656086 DOI: 10.1038/eye.2015.230] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/08/2015] [Indexed: 11/09/2022] Open
Abstract
PurposeTo investigate microanatomical relationships during surgical repair of macula involving retinal detachment with pars plana vitrectomy (PPV) and perfluoron (PFO) with a microscope-integrated intraoperative optical coherence tomography (iOCT) device.Patients and methodsThis consecutive case series included nine eyes of nine patients with macula involving retinal detachment operated by a single surgeon at the Cincinnati Eye Institute. All patients underwent PPV, PFO injection, endolaser, and air-fluid exchange. The macula was imaged with iOCT before PFO injection, after PFO injection, and after air-fluid exchange in all eyes.ResultsiOCT imaging was ergonomically easy to obtain in all eyes. iOCT clearly demonstrated submacular fluid (SMF) at the beginning of the surgery, macular flattening under PFO in all eyes, small residual SMF under PFO in six of nine eyes, and increased occult SMF following air-fluid exchange in all eyes.ConclusionMicroscope-integrated iOCT is a versatile and powerful imaging modality that holds a great deal of promise in the future. Its confirmation of persistent occult SMF in this small series of macular involving retinal detachment repair with PFO, may inform surgical decision making, and demonstrates a pathophysiological rationale for initial face-down positioning after retinal detachment repair.
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Affiliation(s)
- O Toygar
- Retina, Cincinnati Eye Institute, Cincinnati, OH, USA.,Department of Ophthalmology, University of Cincinnati School of Medicine, Cincinnati, OH, USA.,Bahcesehir University Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey
| | - C D Riemann
- Retina, Cincinnati Eye Institute, Cincinnati, OH, USA.,Department of Ophthalmology, University of Cincinnati School of Medicine, Cincinnati, OH, USA
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El-Haddad MT, Tao YK. Automated stereo vision instrument tracking for intraoperative OCT guided anterior segment ophthalmic surgical maneuvers. BIOMEDICAL OPTICS EXPRESS 2015; 6:3014-31. [PMID: 26309764 PMCID: PMC4541528 DOI: 10.1364/boe.6.003014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/04/2015] [Accepted: 07/20/2015] [Indexed: 05/24/2023]
Abstract
Microscope-integrated intraoperative OCT (iOCT) enables imaging of tissue cross-sections concurrent with ophthalmic surgical maneuvers. However, limited acquisition rates and complex three-dimensional visualization methods preclude real-time surgical guidance using iOCT. We present an automated stereo vision surgical instrument tracking system integrated with a prototype iOCT system. We demonstrate, for the first time, automatically tracked video-rate cross-sectional iOCT imaging of instrument-tissue interactions during ophthalmic surgical maneuvers. The iOCT scan-field is automatically centered on the surgical instrument tip, ensuring continuous visualization of instrument positions relative to the underlying tissue over a 2500 mm(2) field with sub-millimeter positional resolution and <1° angular resolution. Automated instrument tracking has the added advantage of providing feedback on surgical dynamics during precision tissue manipulations because it makes it possible to use only two cross-sectional iOCT images, aligned parallel and perpendicular to the surgical instrument, which also reduces both system complexity and data throughput requirements. Our current implementation is suitable for anterior segment surgery. Further system modifications are proposed for applications in posterior segment surgery. Finally, the instrument tracking system described is modular and system agnostic, making it compatible with different commercial and research OCT and surgical microscopy systems and surgical instrumentations. These advances address critical barriers to the development of iOCT-guided surgical maneuvers and may also be translatable to applications in microsurgery outside of ophthalmology.
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Affiliation(s)
- Mohamed T. El-Haddad
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
- Department of Ophthalmic Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | - Yuankai K. Tao
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
- Department of Ophthalmic Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Hahn P, Carrasco-Zevallos O, Cunefare D, Migacz J, Farsiu S, Izatt JA, Toth CA. Intrasurgical Human Retinal Imaging With Manual Instrument Tracking Using a Microscope-Integrated Spectral-Domain Optical Coherence Tomography Device. Transl Vis Sci Technol 2015; 4:1. [PMID: 26175961 DOI: 10.1167/tvst.4.4.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/28/2015] [Indexed: 11/24/2022] Open
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.
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Affiliation(s)
- Paul Hahn
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | | | - David Cunefare
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Justin Migacz
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Sina Farsiu
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA ; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Joseph A Izatt
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA ; Department of Biomedical Engineering, Duke University, Durham, NC, USA
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Abstract
Real-time intraoperative B-scan optical coherence tomography (OCT) visualization of intraocular tissues is a desired ophthalmic feature during retinal procedures. A novel intraocular 25-gauge B-mode forward-imaging OCT probe was combined with a 36-gauge needle into a prototype instrument. Imaging of the needle tip itself and the effects of saline injection into a gelatin phantom were performed. A combined B-scan forward-imaging OCT-needle prototype was capable of real-time-imaging of saline injection into a gelatin phantom. Additional future miniaturization may permit this instrument to be an adjunctive realtime imaging and procedure tool for vitreoretinal surgery.
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Yu H, Shen JH, Shah RJ, Simaan N, Joos KM. Evaluation of microsurgical tasks with OCT-guided and/or robot-assisted ophthalmic forceps. BIOMEDICAL OPTICS EXPRESS 2015; 6:457-72. [PMID: 25780736 PMCID: PMC4354581 DOI: 10.1364/boe.6.000457] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/22/2014] [Indexed: 05/03/2023]
Abstract
Real-time intraocular optical coherence tomography (OCT) visualization of tissues with surgical feedback can enhance retinal surgery. An intraocular 23-gauge B-mode forward-imaging co-planar OCT-forceps, coupling connectors and algorithms were developed to form a unique ophthalmic surgical robotic system. Approach to the surface of a phantom or goat retina by a manual or robotic-controlled forceps, with and without real-time OCT guidance, was performed. Efficiency of lifting phantom membranes was examined. Placing the co-planar OCT imaging probe internal to the surgical tool reduced instrument shadowing and permitted constant tracking. Robotic assistance together with real-time OCT feedback improved depth perception accuracy. The first-generation integrated OCT-forceps was capable of peeling membrane phantoms despite smooth tips.
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Affiliation(s)
- Haoran Yu
- Mechanical Engineering, Vanderbilt University, 2400 Highland Ave Nashville, TN 37212,
USA
- Vanderbilt Initiative in Surgery and Engineering(ViSE), Vanderbilt University 2525 West End Avenue, 6th Floor, Nashville, TN 37203,
USA
| | - Jin-Hui Shen
- Vanderbilt Eye Institute, Vanderbilt University 2311 Pierce Avenue Nashville, TN 37232,
USA
- Vanderbilt Initiative in Surgery and Engineering(ViSE), Vanderbilt University 2525 West End Avenue, 6th Floor, Nashville, TN 37203,
USA
| | - Rohan J. Shah
- Vanderbilt Eye Institute, Vanderbilt University 2311 Pierce Avenue Nashville, TN 37232,
USA
| | - Nabil Simaan
- Mechanical Engineering, Vanderbilt University, 2400 Highland Ave Nashville, TN 37212,
USA
- Vanderbilt Initiative in Surgery and Engineering(ViSE), Vanderbilt University 2525 West End Avenue, 6th Floor, Nashville, TN 37203,
USA
| | - Karen M. Joos
- Vanderbilt Eye Institute, Vanderbilt University 2311 Pierce Avenue Nashville, TN 37232,
USA
- Vanderbilt Initiative in Surgery and Engineering(ViSE), Vanderbilt University 2525 West End Avenue, 6th Floor, Nashville, TN 37203,
USA
- Vanderbilt Biomedical Photonics Laboratories, Vanderbilt University 100 Keck FEL Center, Nashville, TN 37203,
USA
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Ehlers JP, Itoh Y, Xu LT, Kaiser PK, Singh RP, Srivastava SK. Factors associated with persistent subfoveal fluid and complete macular hole closure in the PIONEER study. Invest Ophthalmol Vis Sci 2014; 56:1141-6. [PMID: 25525173 DOI: 10.1167/iovs.14-15765] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To investigate preoperative and intraoperative factors associated with persistent subfoveal fluid in surgically closed macular holes (MHs). METHODS This was a prospective consecutive case series of eyes undergoing surgical repair for full-thickness MH in the PIONEER study, a prospective intraoperative optical coherence tomography (OCT) multisurgeon single-center study. Thirty-seven eyes (36 patients) with surgically closed MH were studied. Quantitative OCT analysis was performed including intraoperative MH area, volume, ellipsoid zone to retinal pigment epithelium (EZ-RPE) height, extent of subretinal hyporeflectivity (SRHR), and the amount of postoperative subfoveal fluid. RESULTS Persistent subfoveal fluid was identified in 58% of eyes at 2 weeks following surgery. The mean time to two-line improvement in visual acuity was greater in eyes with persistent subfoveal fluid (P = 0.03). Final visual acuity did not correlate with the initial presence of fluid. Two intraoperative factors following internal limiting membrane (ILM) peeling were associated with the formation of persistent subfoveal fluid: EZ-RPE height and SRHR width (P < 0.01). These were both negatively correlated with amount of postoperative subfoveal fluid (P = 0.028 and 0.04, respectively). CONCLUSIONS Persistent subfoveal fluid following MH surgery is a common finding that appears to delay visual recovery but not effect final visual outcome. The incidence of persistent subfoveal fluid appears to be related to intraoperative alterations after ILM peeling in the outer retinal architecture (e.g., increased EZ-RPE height and SRHR width). This finding suggests a novel mechanism for facilitating MH closure through ILM peeling (e.g., altering photoreceptor/RPE adherence and increasing retinal mobility that allows for complete hole closure).
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Affiliation(s)
- Justis P Ehlers
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Yuji Itoh
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Lucy T Xu
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Peter K Kaiser
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Rishi P Singh
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Sunil K Srivastava
- Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
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Wieser W, Draxinger W, Klein T, Karpf S, Pfeiffer T, Huber R. High definition live 3D-OCT in vivo: design and evaluation of a 4D OCT engine with 1 GVoxel/s. BIOMEDICAL OPTICS EXPRESS 2014; 5:2963-77. [PMID: 25401010 PMCID: PMC4230855 DOI: 10.1364/boe.5.002963] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 05/18/2023]
Abstract
We present a 1300 nm OCT system for volumetric real-time live OCT acquisition and visualization at 1 billion volume elements per second. All technological challenges and problems associated with such high scanning speed are discussed in detail as well as the solutions. In one configuration, the system acquires, processes and visualizes 26 volumes per second where each volume consists of 320 x 320 depth scans and each depth scan has 400 usable pixels. This is the fastest real-time OCT to date in terms of voxel rate. A 51 Hz volume rate is realized with half the frame number. In both configurations the speed can be sustained indefinitely. The OCT system uses a 1310 nm Fourier domain mode locked (FDML) laser operated at 3.2 MHz sweep rate. Data acquisition is performed with two dedicated digitizer cards, each running at 2.5 GS/s, hosted in a single desktop computer. Live real-time data processing and visualization are realized with custom developed software on an NVidia GTX 690 dual graphics processing unit (GPU) card. To evaluate potential future applications of such a system, we present volumetric videos captured at 26 and 51 Hz of planktonic crustaceans and skin.
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Affiliation(s)
- Wolfgang Wieser
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Oettingenstr. 67, 80538 Munich, Germany
| | - Wolfgang Draxinger
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Oettingenstr. 67, 80538 Munich, Germany
| | - Thomas Klein
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Oettingenstr. 67, 80538 Munich, Germany
| | - Sebastian Karpf
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Oettingenstr. 67, 80538 Munich, Germany
| | - Tom Pfeiffer
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Oettingenstr. 67, 80538 Munich, Germany
| | - Robert Huber
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik, Ludwig-Maximilians-Universität München, Oettingenstr. 67, 80538 Munich, Germany
- Institut für Biomedizinische Optik, Universität zu Lübeck, Peter-Monnik-Weg 4, 23562 Lübeck Germany
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Allen J, Howell K. Microvascular imaging: techniques and opportunities for clinical physiological measurements. Physiol Meas 2014; 35:R91-R141. [DOI: 10.1088/0967-3334/35/7/r91] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Goldberg RA, Waheed NK, Duker JS. Optical coherence tomography in the preoperative and postoperative management of macular hole and epiretinal membrane. Br J Ophthalmol 2014; 98 Suppl 2:ii20-3. [PMID: 24627250 PMCID: PMC4208342 DOI: 10.1136/bjophthalmol-2013-304447] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Optical coherence tomography (OCT) imaging plays an essential role in the diagnosis and treatment of macular diseases, including those of the vitreomacular interface. OCT enables accurate diagnosis and differentiation of full thickness macular hole, lamellar macular hole and epiretinal membrane, with or without the presence of vitreomacular adhesion. This information enables earlier diagnosis and treatment when necessary, and can guide the choice of therapy. OCT is useful to facilitate discussions with patients and manage the visual expectations. Postoperatively, OCT can be helpful to optimise patient comfort and visual outcomes. As the technology continues to improve, OCT will become increasingly critical for all aspects of care for patients with macular hole and epiretinal membrane.
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Affiliation(s)
- Roger A Goldberg
- New England Eye Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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Lee C, Kim K, Han S, Kim S, Lee JH, Kim HK, Kim C, Jung W, Kim J. Stimulated penetrating keratoplasty using real-time virtual intraoperative surgical optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:30502. [PMID: 24604471 PMCID: PMC4019417 DOI: 10.1117/1.jbo.19.3.030502] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/31/2013] [Accepted: 01/13/2014] [Indexed: 05/20/2023]
Abstract
An intraoperative surgical microscope is an essential tool in a neuro- or ophthalmological surgical environment. Yet, it has an inherent limitation to classify subsurface information because it only provides the surface images. To compensate for and assist in this problem, combining the surgical microscope with optical coherence tomography (OCT) has been adapted. We developed a real-time virtual intraoperative surgical OCT (VISOCT) system by adapting a spectral-domain OCT scanner with a commercial surgical microscope. Thanks to our custom-made beam splitting and image display subsystems, the OCT images and microscopic images are simultaneously visualized through an ocular lens or the eyepiece of the microscope. This improvement helps surgeons to focus on the operation without distraction to view OCT images on another separate display. Moreover, displaying the OCT live images on the eyepiece helps surgeon's depth perception during the surgeries. Finally, we successfully processed stimulated penetrating keratoplasty in live rabbits. We believe that these technical achievements are crucial to enhance the usability of the VISOCT system in a real surgical operating condition.
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Affiliation(s)
- Changho Lee
- Pohang University of Science and Technology (POSTECH), Departments of Electrical Engineering and Creative IT Engineering, Pohang 790-784, Republic of Korea
| | - Kyungun Kim
- Kyungpook National University, School of Electronics Engineering, Daegu 702-701, Republic of Korea
| | - Seunghoon Han
- Kyungpook National University, School of Electronics Engineering, Daegu 702-701, Republic of Korea
| | - Sehui Kim
- Kyungpook National University, School of Electronics Engineering, Daegu 702-701, Republic of Korea
| | - Jun Hoon Lee
- Metro Eye Center, Daegu 700-733, Republic of Korea
| | - Hong kyun Kim
- Kyungpook National University Hospital, Department of Ophthalmology, College of Medicine, Daegu 700-721, Republic of Korea
| | - Chulhong Kim
- Pohang University of Science and Technology (POSTECH), Departments of Electrical Engineering and Creative IT Engineering, Pohang 790-784, Republic of Korea
| | - Woonggyu Jung
- Ulsan National Institute of Science and Technology, School of Nano-Bioscience & Chemical Engineering, Ulsan 689-798, Republic of Korea
| | - Jeehyun Kim
- Kyungpook National University, School of Electronics Engineering, Daegu 702-701, Republic of Korea
- Address all correspondence to: Jeehyun Kim, E-mail:
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Preclinical evaluation and intraoperative human retinal imaging with a high-resolution microscope-integrated spectral domain optical coherence tomography device. Retina 2014; 33:1328-37. [PMID: 23538579 DOI: 10.1097/iae.0b013e3182831293] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The authors have recently developed a high-resolution microscope-integrated spectral domain optical coherence tomography (MIOCT) device designed to enable OCT acquisition simultaneous with surgical maneuvers. The purpose of this report is to describe translation of this device from preclinical testing into human intraoperative imaging. METHODS Before human imaging, surgical conditions were fully simulated for extensive preclinical MIOCT evaluation in a custom model eye system. Microscope-integrated spectral domain OCT images were then acquired in normal human volunteers and during vitreoretinal surgery in patients who consented to participate in a prospective institutional review board-approved study. Microscope-integrated spectral domain OCT images were obtained before and at pauses in surgical maneuvers and were compared based on predetermined diagnostic criteria to images obtained with a high-resolution spectral domain research handheld OCT system (HHOCT; Bioptigen, Inc) at the same time point. Cohorts of five consecutive patients were imaged. Successful end points were predefined, including ≥80% correlation in identification of pathology between MIOCT and HHOCT in ≥80% of the patients. RESULTS Microscope-integrated spectral domain OCT was favorably evaluated by study surgeons and scrub nurses, all of whom responded that they would consider participating in human intraoperative imaging trials. The preclinical evaluation identified significant improvements that were made before MIOCT use during human surgery. The MIOCT transition into clinical human research was smooth. Microscope-integrated spectral domain OCT imaging in normal human volunteers demonstrated high resolution comparable to tabletop scanners. In the operating room, after an initial learning curve, surgeons successfully acquired human macular MIOCT images before and after surgical maneuvers. Microscope-integrated spectral domain OCT imaging confirmed preoperative diagnoses, such as full-thickness macular hole and vitreomacular traction, and demonstrated postsurgical changes in retinal morphology. Two cohorts of five patients were imaged. In the second cohort, the predefined end points were exceeded with ≥80% correlation between microscope-mounted OCT and HHOCT imaging in 100% of the patients. CONCLUSION This report describes high-resolution MIOCT imaging using the prototype device in human eyes during vitreoretinal surgery, with successful achievement of predefined end points for imaging. Further refinements and investigations will be directed toward fully integrating MIOCT with vitreoretinal and other ocular surgery to image surgical maneuvers in real time.
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Abstract
Medical imaging plays a critical role in cancer diagnosis and planning. Many of these patients rely on surgical intervention for curative outcomes. This requires a careful identification of the primary and microscopic tumors, and the complete removal of cancer. Although there have been efforts to adapt traditional-imaging modalities for intraoperative image guidance, they suffer from several constraints such as large hardware footprint, high-operation cost, and disruption of the surgical workflow. Because of the ease of image acquisition, relatively low-cost devices and intuitive operation, optical imaging methods have received tremendous interests for use in real-time image-guided surgery. To improve imaging depth under low interference by tissue autofluorescence, many of these applications utilize light in the near-infrared (NIR) wavelengths, which is invisible to human eyes. With the availability of a wide selection of tumor-avid contrast agents, advancements in imaging sensors, electronic and optical designs, surgeons are able to combine different attributes of NIR optical imaging techniques to improve treatment outcomes. The emergence of diverse commercial and experimental image guidance systems, which are in various stages of clinical translation, attests to the potential high impact of intraoperative optical imaging methods to improve speed of oncologic surgery with high accuracy and minimal margin positivity.
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Affiliation(s)
- Suman B Mondal
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Shengkui Gao
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Nan Zhu
- College of Optical Sciences, University of Arizona, Tucson, Arizona, USA
| | - Rongguang Liang
- College of Optical Sciences, University of Arizona, Tucson, Arizona, USA
| | - Viktor Gruev
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Samuel Achilefu
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA.
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Piñero DP. Technologies for anatomical and geometric characterization of the corneal structure and anterior segment: a review. Semin Ophthalmol 2013; 30:161-70. [PMID: 24175646 DOI: 10.3109/08820538.2013.835844] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Corneal and anterior segment imaging techniques have become a crucial tool in the clinical practice of ophthalmology, with a great variety of applications, such as corneal curvature and pachymetric analysis, detection of ectatic corneal conditions, anatomical study of the anterior segment prior to phakic intraocular lens implantation, or densitometric analysis of the crystalline lens. From the Placido-based systems that allow only a characterization of the geometry of the anterior corneal surface to the Scheimpflug photography-based systems that provide a characterization of the cornea, anterior chamber, and crystalline lens, there is a great variety of devices with the capability of analyzing different anatomical parameters with very high precision. To date, Scheimpflug photography-based systems are the devices providing the more complete analysis of the anterior segment in a non-invasive way. More developments are required in anterior segment imaging technologies in order to improve the analysis of the crystalline lens structure as well as the ocular structures behind the iris in a non-invasive way when the pupil is not dilated.
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Affiliation(s)
- David P Piñero
- Department of Ophthalmology (Oftalmar), Medimar International Hospital , Alicante , Spain
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