Anterior Segment Optical Coherence Tomography–Guided Big-Bubble Technique

Scorcia, Vincenzo; Busin, Massimo; Lucisano, Andrea; Beltz, Jacqueline; Carta, Arturo; Scorcia, G

doi:10.1016/j.ophtha.2012.08.041

Cited by 95 publications

(96 citation statements)

References 20 publications

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“…[6][7][8][9] Nonetheless, compaction of the anterior stroma could theoretically hinder formation of the "Big Bubble" cleavage plane in the posterior stroma and therefore concerns have been raised about the possibility of performing a successful "Big Bubble" technique in corneas previously treated with CXL. 10 We report a series of patients who had CXL and underwent the "Big Bubble" technique for DALK for keratoconus progression. Data are expressed as mean ± standard deviation.…”

mentioning

confidence: 99%

Big Bubble DALK After CXL in Keratoconic Patients

Iovieno¹,

Moramarco²,

Coassin³

et al. 2013

J Refract Surg

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mentioning

confidence: 99%

Big Bubble DALK After CXL in Keratoconic Patients

Iovieno¹,

Moramarco²,

Coassin³

et al. 2013

J Refract Surg

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“…[6][7][8][9][10][11][12][13][14][15][16][17] Multiple approaches to image acquisition can be used with these systems, including handheld, external mounting, and microscope mounting.…”

Section: Intraoperative Oct Systems and Devicesmentioning

confidence: 99%

“…[6][7][8][9][11][12][13][14][15][16][17][18][21][22][23]27,28,[32][33][34][35][36][37][38][39][40][41] The PIONEER study was a large prospective clinical study (n = 531) examining the role of intraoperative OCT with a microscope-mounted portable OCT system in ophthalmic surgery. 13 The DISCOVER study is a subsequent prospective clinical study (n = 227) examining microscope-integrated OCT in ophthalmic surgery.…”

Section: Clinical Use and Impactmentioning

confidence: 99%

“…9,12,13,22,23,27,29,32,39,41,42 Using intraoperative OCT surgeons are able to obtain immediate feedback on the status of the surgical procedure.…”

Section: Anterior Segmentmentioning

confidence: 99%

“…In addition, there is preliminary evidence that intraoperative OCT-guided DMEK may help facilitate the transition from DSAEK to DMEK for the novice DMEK surgeon. 27 In deep anterior lamellar keratoplasty (DALK), multiple studies have reported improved visualization and understanding of dissection depth with intraoperative OCT. 12,13,27,32 In fact, one study reported that dissection depth measured with intraoperative OCT appeared to be an important factor for successful DALK without conversion to full-thickness penetrating keratoplasty. 12 The PIONEER and DISCOVER studies confirmed the potential role of intraoperative OCT in DALK.…”

Section: Anterior Segmentmentioning

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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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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Anterior Segment Optical Coherence Tomography–Guided Big-Bubble Technique

Cited by 95 publications

References 20 publications

Big Bubble DALK After CXL in Keratoconic Patients

Big Bubble DALK After CXL in Keratoconic Patients

Intraoperative optical coherence tomography: past, present, and future

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

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