Integration of a Spectral Domain Optical Coherence Tomography System into a Surgical Microscope for Intraoperative Imaging

Ehlers, Justis P.; Tao, Yuankai K.; Farsiu, Sina; Maldonado, Ramiro S.; Izatt, Joseph A.; Toth, Cynthia A.

doi:10.1167/iovs.10-6720

Cited by 135 publications

(120 citation statements)

References 18 publications

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“…Adaptation of both Leica (Leica, Wetzlar, Germany) and Zeiss (Carl Zeiss Meditec, Oberkochen, Germany) were among the first systems described. [19][20][21] The Zeiss adaptation used a modified Cirrus (Carl Zeiss Meditec) OCT system adapted for integration into the Zeiss microscope optical path. 21 For anterior segment imaging, a modified Visante (Carl Zeiss Meditec) prototype was also integrated into a Zeiss microscope.…”

Section: Intraoperative Oct Systems and Devicesmentioning

confidence: 99%

“…22,23 Similarly, the Leica adaptation used a separate OCT scan head that was mounted to the bottom of the microscope body and integrated the optical paths of the two systems. 19,20 These systems provided the first insights of the potential of 'real-time' intraoperative OCT allowing for OCT-based visualization of instrument-tissue interaction and immediate imaging with surgeon feedback. 21,24 However, these systems also uncovered new challenges for intraoperative OCT development, including the need for new software systems, the limits of current instrumentation for OCT compatibility, and need for heads-up visualization.…”

Section: Intraoperative Oct Systems and Devicesmentioning

confidence: 99%

“…21,24 However, these systems also uncovered new challenges for intraoperative OCT development, including the need for new software systems, the limits of current instrumentation for OCT compatibility, and need for heads-up visualization. 19,21 In addition, the need for Z axis stabilization to maximize image visualization during surgical maneuvers was identified owing to the intermittent vertical displacement that occurs during surgical maneuvers. Methods for automated tracking and/or surgeon directed maneuvering of the OCT beam to areas of interest were also lacking.…”

Section: Intraoperative Oct Systems and Devicesmentioning

confidence: 99%

“…19,21,27 This limits visualization of tissue-instrument interactions with intraoperative OCT. Novel material testing and prototype development is underway to maximize OCT-based visualization whereas maintaining the surgical precision required for ophthalmic surgery.…”

Section: Future Needs and Directionsmentioning

confidence: 99%

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Intraoperative optical coherence tomography: past, present, and future

Ehlers

2015

Eye

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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 microscopeintegrated 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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Section: Intraoperative Oct Systems and Devicesmentioning

confidence: 99%

Section: Intraoperative Oct Systems and Devicesmentioning

confidence: 99%

Section: Intraoperative Oct Systems and Devicesmentioning

confidence: 99%

Section: Future Needs and Directionsmentioning

confidence: 99%

See 2 more Smart Citations

Intraoperative optical coherence tomography: past, present, and future

Ehlers

2015

Eye

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“…Intraoperative OCT (iOCT) has recently been introduced by several research groups, [1][2][3][4] and has been reported to be useful in vitreoretinal, [5][6][7][8] anterior segment, [9][10][11] and glaucoma surgery. 12 In Europe and in the United States, microscopeintegrated iOCT units are commercially available from two different manufacturers.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative optical coherence tomography in macula involving rhegmatogenous retinal detachment repair with pars plana vitrectomy and perfluoron

Toygar

Riemann

2015

Eye

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Determination of Feasibility and Utility of Microscope-Integrated Optical Coherence Tomography During Ophthalmic Surgery

et al. 2015

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

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Integration of a Spectral Domain Optical Coherence Tomography System into a Surgical Microscope for Intraoperative Imaging

Cited by 135 publications

References 18 publications

Intraoperative optical coherence tomography: past, present, and future

Intraoperative optical coherence tomography: past, present, and future

Intraoperative optical coherence tomography in macula involving rhegmatogenous retinal detachment repair with pars plana vitrectomy and perfluoron

Determination of Feasibility and Utility of Microscope-Integrated Optical Coherence Tomography During Ophthalmic Surgery

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