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Intraoperative optische Kohärenztomographie bei hornhaut- und glaukomchirurgischen Eingriffen

Intraoperative optical coherence tomography in corneal and glaucoma surgical procedures

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Zusammenfassung

Hintergrund

Die optische Kohärenztomographie (OCT) ist der klinische Goldstandard zur Beurteilung von Strukturen des vorderen und hinteren Augenabschnittes. Seitdem OCT-Geräte in Operationsmikroskope integriert wurden, steht diese Technik auch intraoperativ zur Verfügung. Insbesondere bei sehr dünnen oder transparenten Strukturen, wie sie bei der Hornhaut- oder Glaukomchirurgie entstehen, könnte sie dem Chirurgen wichtige Informationen liefern, die über das normale Operationsmikroskop hinausgehen.

Ziel der Arbeit

Die vorliegende Arbeit gibt einen Überblick über die Möglichkeiten der intraoperativen OCT-Technik bei hornhaut- und glaukomchirurgischen Eingriffen.

Material und Methoden

Der Beitrag basiert auf einer Literaturübersicht (PUBMED) und eigenen klinischen Erfahrungen am Zentrum für Augenheilkunde der Uniklinik Köln.

Ergebnisse

Sowohl bei hornhaut- als auch bei glaukomchirurgischen Prozeduren liefert die intraoperative OCT wichtige Informationen, die das normale Operationsmikroskop ergänzen. Insbesondere bei lamellären Keratoplastiken hilft das OCT zuverlässig z. B. bei der Tiefenabschätzung und relativen Hornhautdickenbestimmung. Auch in der Glaukomchirurgie wie bei der Kanaloplastik oder dem Trabektom ist die OCT als kontaktloses und hochauflösendes Verfahren der Ultraschallbiomikroskopie überlegen.

Diskussion

Die intraoperative OCT bietet eine sinnvolle Ergänzung zum normalen Operationsmikroskop bei der Hornhaut- und Glaukomchirurgie. Dabei wird die Bildgebung zurzeit noch hauptsächlich von intransparenten Instrumenten, die Artefakte produzieren, limitiert. Zudem fehlen große randomisiert kontrollierte Studien, die die Überlegenheit der mikroskopintegrierten intraoperativen OCT im Vergleich zum alleinigen Mikroskop belegen.

Abstract

Background

Optical coherence tomography (OCT) is the clinical gold standard for anterior and posterior segment imaging. Since OCT devices have been integrated into surgical microscopes, this technique is also available intraoperatively in anterior segment surgery. OCT is well established in imaging very thin or transparent structures as they appear in corneal or glaucoma surgery. Therefore, intraoperative OCT can deliver important information for the surgeon which is superior to the normal surgical microscope.

Objectives

In the present work, an overview about the opportunities of intraoperative OCT in cornea and glaucoma surgery are presented.

Material and methods

The recent literature (PubMed) and our own experience at the Center for Ophthalmology, University Hospital of Cologne are analysed.

Results

Intraoperative OCT enables real-time imaging during corneal and glaucoma surgery. Several clinical studies exist, indicating its benefit, e. g. in DMEK, DALK, DSAEK, Boston Keratoprosthesis, canaloplasty or trabectome surgery. Several structures, not visible in the surgical microscope, can be visualized using intraoperative OCT.

Conclusions

As a real-time and high-resolution imaging device, intraoperative online OCT delivers additional information in glaucoma and corneal surgery, compared to the normal operating microscope. Nonetheless one of the main problems is the shadowing produced by surgical instruments. Today the main limitation is the lack of randomized-controlled clinical trials, evaluating the benefit of microscope-integrated intraoperative OCT, compared to the microscope.

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Finanzierung

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, M. Hermann, S. Roters, C. Cursiefen & P. Steven

  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. M. Hermann
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  6. S. Roters
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  7. C. Cursiefen
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  8. P. Steven
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Corresponding author

Correspondence to S. Siebelmann.

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Interessenkonflikt

B. Bachmann, A. Lappas, T. Dietlein, M. Hermann, S. Roters 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 Vertragshonorare 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 hornhaut- und glaukomchirurgischen Eingriffen. Ophthalmologe 113, 646–650 (2016). https://doi.org/10.1007/s00347-016-0320-y

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  • DOI: https://doi.org/10.1007/s00347-016-0320-y

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