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Intraoperative optische Kohärenztomographie bei Narkoseuntersuchungen von Säuglingen und Kleinkindern

Intraoperative optical coherence tomography for examination of newborns and infants under general anesthesia

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Zusammenfassung

Hintergrund

Narkoseuntersuchungen von Kindern sind notwendig, um die Entwicklung einer Amblyopie zu vermeiden. Ihre Aussagekraft ist allerdings oftmals durch den Mangel an State-of-the-Art-Diagnostik, wie z. B. der optischen Kohärenztomographie (OCT), eingeschränkt. Seitdem neuerdings die OCT-Technik in Operationsmikroskope integriert wurde, steht diese Technik auch im Operationssaal bei Untersuchungen in Vollnarkose zur Verfügung.

Ziel der Arbeit

Die vorliegende Arbeit gibt einen Überblick über die Möglichkeiten der intraoperativen OCT-Technik bei der Narkoseuntersuchung von Kindern.

Material und Methoden

Zugrunde gelegt wurden eine Literaturübersicht (PUBMED) und eigene klinische Erfahrungen am Zentrum für Augenheilkunde der Uniklinik Köln.

Ergebnisse

Die intraoperative OCT-Technik ermöglicht eine Echtzeitbildgebung während der Narkoseuntersuchung von Säuglingen und Kindern. Sie ist in der Lage, alle Strukturen des vorderen Augenabschnittes darzustellen (Hornhaut, Linse, Kammerwinkel, Iris). Zudem liefert sie, insbesondere bei reduziertem Einblick in die Augenvorderkammer, wichtige strukturelle Informationen, die über den Erkenntnisgewinn des Mikroskops hinausgehen. Die dabei gewonnenen Informationen sind ausschlaggebend für die Diagnostik und die weitere Therapie der Patienten.

Diskussion

Die intraoperative OCT stellt eine sinnvolle Ergänzung zum normalen Operationsmikroskop dar, insbesondere bei Säuglingen und Kindern mit Anomalien des vorderen Augenabschnittes und reduziertem Einblick in die Vorderkammer. Unseren Erfahrungen nach ist auch eine Ausweitung der Technik auf Anomalien des hinteren Augenabschnitts sinnvoll, da eine Bildgebung von Papille und Makula möglich ist.

Abstract

Background

Examination of newborn and children under general anesthesia is essential to prevent amblyopia and blindness; however, the validity was often limited due to a lack of state of the art diagnostic tools in the intraoperative set-up, e. g. optical coherence tomography (OCT). Since OCT devices have been integrated into surgical microscopes, this technique is also available for examination with patients under general anesthesia.

Objective

To give an overview about the possibilities of intraoperative OCT (iOCT) during examination of newborn and infant children under general anesthesia.

Material and methods

Analysis of recent literature (PubMed) and initial experiences at the Center for Ophthalmology of the University Hospital of Cologne.

Results

The use of iOCT enables real-time high-resolution imaging during examinations of children under general anesthesia. All relevant structures of the anterior eye segment (including cornea, lens, chamber angle and iris) can be visualized. Especially when the anterior chamber view is limited due to corneal opacifications, iOCT can deliver important information in addition to that obtained using a surgical microscope. This information is important for the further therapy of the patients.

Conclusion

Online iOCT is a useful extension of the normal surgical microscope, especially for examination of children under general anesthesia and limited view into the anterior chamber. In our experience it also makes sense to transfer this technique to anomalies of the posterior pole because high-resolution imaging of the macula and optic nerve head is possible.

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Förderung

DFG FOR 2240 „(Lymph)Angiogenesis And Cellular Immunity In Inflammatory Diseases Of The Eye“, www.for2240.de (PS, CC); EU COST BM 1302 (CC, SS); Lingen Foundation, Cologne.

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Authors and Affiliations

  1. Zentrum für Augenheilkunde, Uniklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland

    S. Siebelmann, B. Bachmann, A. Lappas, T. Dietlein, P. Steven & C. Cursiefen

  2. Cluster of Excellence: Cellular Stress Responses in Aging-associated Diseases (CECAD), University of Cologne, Köln, Deutschland

    S. Siebelmann & P. Steven

Authors
  1. S. Siebelmann
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  2. B. Bachmann
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  3. A. Lappas
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  4. T. Dietlein
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  5. P. Steven
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  6. C. Cursiefen
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Corresponding author

Correspondence to S. Siebelmann.

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Interessenkonflikt

B. Bachmann, A. Lappas, T. Dietlein und C. Cursiefen geben an, dass kein Interessenkonflikt besteht. S. Siebelmann erhielt eine Reisekostenförderung von Haag Streit Surgical sowie eine Reisekostenförderung von Bausch und Lomb. Zudem erhielt er 2015 den Sicca-Förderpreis, gesponsert von Bausch und Lomb. P. Steven erhielt Reisekostenförderungen und Vortragshonorare von Haag Streit Surgical.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Siebelmann, S., Bachmann, B., Lappas, A. et al. Intraoperative optische Kohärenztomographie bei Narkoseuntersuchungen von Säuglingen und Kleinkindern. Ophthalmologe 113, 651–655 (2016). https://doi.org/10.1007/s00347-016-0299-4

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  • DOI: https://doi.org/10.1007/s00347-016-0299-4

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