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Unprocessed real-time imaging of vitreoretinal surgical maneuvers using a microscope-integrated spectral-domain optical coherence tomography system

  • Paul Hahn
  • Justin Migacz
  • Rachelle O’Connell
  • Joseph A. Izatt
  • Cynthia A. TothEmail author
Miscellaneous

Abstract

Background

We have recently developed a microscope-integrated spectral-domain optical coherence tomography (MIOCT) device towards intrasurgical cross-sectional imaging of surgical maneuvers. In this report, we explore the capability of MIOCT to acquire real-time video imaging of vitreoretinal surgical maneuvers without post-processing modifications.

Methods

Standard 3-port vitrectomy was performed in human during scheduled surgery as well as in cadaveric porcine eyes. MIOCT imaging of human subjects was performed in healthy normal volunteers and intraoperatively at a normal pause immediately following surgical manipulations, under an Institutional Review Board-approved protocol, with informed consent from all subjects. Video MIOCT imaging of live surgical manipulations was performed in cadaveric porcine eyes by carefully aligning B-scans with instrument orientation and movement. Inverted imaging was performed by lengthening of the reference arm to a position beyond the choroid.

Results

Unprocessed MIOCT imaging was successfully obtained in healthy human volunteers and in human patients undergoing surgery, with visualization of post-surgical changes in unprocessed single B-scans. Real-time, unprocessed MIOCT video imaging was successfully obtained in cadaveric porcine eyes during brushing of the retina with the Tano scraper, peeling of superficial retinal tissue with intraocular forceps, and separation of the posterior hyaloid face. Real-time inverted imaging enabled imaging without complex conjugate artifacts.

Conclusions

MIOCT is capable of unprocessed imaging of the macula in human patients undergoing surgery and of unprocessed, real-time, video imaging of surgical maneuvers in model eyes. These capabilities represent an important step towards development of MIOCT for efficient, real-time imaging of manipulations during human surgery.

Keywords

Optical coherence tomography OCT Intrasurgical Intraoperative Microscope-integrated Vitreoretinal surgery Unprocessed Real-time 

Notes

Acknowledgments

The authors would like to acknowledge Katrina Winters and Michelle McCall for their administrative assistance, along with Tomas Moreno and Eric Yuan for their technical assistance.

Supplementary material

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References

  1. 1.
    Dayani PN, Maldonado R, Farsiu S, Toth CA (2009) Intraoperative use of handheld spectral-domain optical coherence tomography imaging in macular surgery. Retina 29:1457–1468PubMedCrossRefGoogle Scholar
  2. 2.
    Baranano DE, Fortun JA, Ray R, Charkoudian L, Bergstrom C, Cribbs B, Schwent B, Hubbard G, Srivastava S (2010) Intraoperative spectral-domain optical coherence tomography for macular pucker surgery. ARVO Meeting Abstracts 51:269Google Scholar
  3. 3.
    Lee LB, Srivastava SK (2011) Intraoperative spectral-domain optical coherence tomography during complex retinal detachment repair. Ophthalmic Surg Lasers Imaging 42 Online: e71–e74Google Scholar
  4. 4.
    Ray R, Baranano DE, Fortun JA, Schwent BJ, Cribbs BE, Bergstrom CS, Hubbard GB 3rd, Srivastava SK (2011) Intraoperative microscope-mounted spectral-domain optical coherence tomography for evaluation of retinal anatomy during macular surgery. Ophthalmology 118:2212–2217PubMedCrossRefGoogle Scholar
  5. 5.
    Wykoff CC, Berrocal AM, Schefler AC, Uhlhorn SR, Ruggeri M, Hess D (2010) Intraoperative OCT of a full-thickness macular hole before and after internal limiting membrane peeling. Ophthalmic Surg Lasers Imaging 41:7–11PubMedCrossRefGoogle Scholar
  6. 6.
    Scott AW, Farsiu S, Enyedi LB, Wallace DK, Toth CA (2009) Imaging the infant retina with a hand-held spectral-domain optical coherence tomography device. Am J Ophthalmol 147(364–373):e362Google Scholar
  7. 7.
    Hahn P, Migacz J, O'Connell R, Maldonado R, Izatt JA, Toth CA (2011) The use of optical coherence tomography in intraoperative ophthalmic imaging. Ophthalmic Surg Lasers Imaging 42:S85–S94PubMedCrossRefGoogle Scholar
  8. 8.
    Han S, Sarunic MV, Wu J, Humayun M, Yang C (2008) Handheld forward-imaging needle endoscope for ophthalmic optical coherence tomography inspection. J Biomed Opt 13:020505PubMedCrossRefGoogle Scholar
  9. 9.
    Balicki M, Han JH, Iordachita I, Gehlbach P, Handa J, Taylor R, Kang J (2009) Single fiber optical coherence tomography microsurgical instruments for computer and robot-assisted retinal surgery. Med Image Comput Comput Assist Interv 12:108–115PubMedGoogle Scholar
  10. 10.
    Binder S, Falkner-Radler CI, Hauger C, Matz H, Glittenberg C (2011) Feasibility of Intrasurgical spectral-domain optical coherence tomography. Retina 31:1332–1336PubMedCrossRefGoogle Scholar
  11. 11.
    Tao YK, Ehlers JP, Toth CA, Izatt JA (2010) Intraoperative spectral-domain optical coherence tomography for vitreoretinal surgery. Opt Lett 35:3315–3317PubMedCrossRefGoogle Scholar
  12. 12.
    Ehlers JP, Tao YK, Farsiu S, Maldonado R, Izatt JA, Toth CA (2011) Integration of a spectral-domain optical coherence tomography system into a surgical microscope for intraoperative imaging. Invest Ophthalmol Vis Sci 52:3153–3159PubMedCrossRefGoogle Scholar
  13. 13.
    Tao YK, Ehlers JP, Toth CA, Izatt JA (2011) Visualization of vitreoretinal surgical manipulations using intraoperative spectral-domain optical coherence tomography. Proc SPIE 7889:78890FCrossRefGoogle Scholar
  14. 14.
    Spaide RF, Koizumi H, Pozzoni MC (2008) Enhanced depth imaging spectral-domain optical coherence tomography. Am J Ophthalmol 146:496–500PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Paul Hahn
    • 1
  • Justin Migacz
    • 2
  • Rachelle O’Connell
    • 1
  • Joseph A. Izatt
    • 1
    • 2
  • Cynthia A. Toth
    • 1
    • 2
    Email author
  1. 1.Department of OphthalmologyDuke University Eye CenterDurhamUSA
  2. 2.Department of Biomedical EngineeringDuke UniversityDurhamUSA

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