Contrast-enhanced intraoperative optical coherence tomography

Abstract

Optical coherence tomography (OCT) has revolutionised clinical ophthalmology. The translation of OCT into the operating room is a natural next step given its high-resolution anatomic information. Contrast agents and enhancement have significantly improved the diagnostic capabilities of numerous imaging modalities (such as CT and MRI). The use of OCT contrast agents in ophthalmology has been generally lacking. In this report, we describe the novel application of triamcinolone as an OCT contrast agent for intraoperative OCT to improve visibility of tissue interfaces and planes (eg, posterior hyaloid insertion points). The application of this technology may have wide-ranging implications for enhanced image-guided surgery, intraoperative OCT and dynamic or functional applications of OCT technology.

Visualisation of contrast-enhanced intraoperative optical coherence tomography with indocyanine green

“…Interestingly, prednisolone acetate allows for adequate contrast of both the tear film and corneal wounds with decreased subjective shadowing of subcontrast structures when compared with ICG and triamcinolone. The reflectivity profiles visualised for triamcinolone and prednisolone mirror our previously published results on contrast-enhanced OCT. [7][8][9] This study does have important limitations, including its small size and retrospective nature. Further prospective research is needed to better understand the potential role of ICG-enhanced OCT-based visualisation of ocular structures during iOCT.…”

“…Use of different OCT contrast agents have been previously reported including prednisolone, lipid-based artificial tears and triamcinolone with promising results. [7][8][9] In our review of the literature, this represents the first description of the in vivo OCT properties of ICG used during a surgical procedure. This increased reflectivity, however, came with decreased visualisation of the tissues below the ICG contrast.…”

“…The application of contrast agents during iOCT could potentially enhance surgeon feedback and visualisation of tissues of interest during surgical procedures. [7][8][9] As previously described, agents such as triamcinolone, prednisolone and lipid-based artificial tears allow for enhanced visualisation of translucent microstructures in both in vivo and ex vivo contrast-enhanced OCT imaging. [7][8][9] In this report, we describe the OCT properties of indocyanine green (ICG; IC-Green, Akorn, Lake Forest, Illinois, USA) as an iOCT contrast agent for ophthalmic surgery.…”

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

“…4,10,22,23 We believe that as this technology continues to be developed, microscopeintegrated iOCT may be preferable to handheld iOCT units 24,25 or iOCT units mounted separate from the microscope on a dedicated swing arm. 5,26 Several studies have reported iOCT findings and all have published selected patient images, which best illustrate the clinical points of the authors. Our report publishes serial images of all patients through BSS, PFO, and air irrespective of corneal irregularity, cataract, or other media opacity.…”

Intraoperative optical coherence tomography: past, present, and future

“…Enhanced visualization through OCT-contrast agents, such as with triamcinolone or indocyanine green, may also be useful to improve tissue layer differentiation. 48,49 Software analysis platforms are currently lacking on commercial devices available for intraoperative OCT. However, studies have demonstrated the ability to analyze with automated algorithms subtle perturbations in the tissues following surgical manipulation.…”