Microscope-Integrated Optical Coherence Tomography Angiography in the Operating Room in Young Children With Retinal Vascular Disease

Abstract

ntraoperative optical coherence tomography (OCT) technology has markedly advanced in the past few years. Intraoperative imaging was first performed with handheld and microscope-mounted spectral domain OCT systems during surgical pauses. 1,2 More recently, both commercial and research spectral-domain, microscope-integrated OCT (MIOCT) systems have been reported. [2][3][4][5] One group showed a custom swept-source, microscope-integrated OCT (SS-MIOCT) system based on a faster 100-kHz laser. 6 The faster scan rate of this laser made possible live volumetric intraoperative imaging and, as reported herein, enabled OCT angiography (OCTA). Optical coherence tomography angiography uses changes in complex OCT signals induced by vascular flow for contrast instead of exogenous fluorescent tracers and has pro-vided substantial insight into retinal vascular abnormalities. [7][8][9] Previous OCTA implementations were limited to tabletop clinical OCT systems, which require cooperative and upright patients for imaging. Here, we report on OCTA integrated into our SS-MIOCT system and describe, to our knowledge, its first use in the operating room during examination under anesthesia (EUA) of 2 young children with retinal vascular disease. MethodsThe research system used a 100-kHz swept-source laser (Axsun Technologies) with a center wavelength of 1050 nm. Intraoperative MIOCT angiography (MIOCTA) was performed IMPORTANCE Intraoperative optical coherence tomography (OCT) has gained traction as an important adjunct for clinical decision making during vitreoretinal surgery, and OCT angiography (OCTA) has provided novel insights in clinical evaluation of retinal diseases. To date, these two technologies have not been applied in combination to evaluate retinal vascular disease in the operating suite.OBJECTIVE To conduct microscope-integrated, swept-source OCTA (MIOCTA) in children with retinal vascular disease. DESIGN, SETTING, AND PARTICIPANTSIn this case report analysis, OCT imaging in pediatric patients, MIOCTA images were obtained during examination under anesthesia from a young boy with a history of idiopathic vitreous hemorrhage and a female infant with familial exudative vitreoretinopathy.MAIN OUTCOMES AND MEASURES Side-by-side comparison of research MIOCT angiograms and clinically indicated fluorescein angiograms. RESULTSIn 2 young children with retinal vascular disease, the MIOCTA images showed more detailed vascular patterns than were visible on the fluorescein angiograms although within a more posterior field of view. The MIOCTA system allowed visualization of small pathological retinal vessels in the retinal periphery that were obscured in the fluorescein angiograms by fluorescein staining from underlying, preexisting laser scars.CONCLUSIONS AND RELEVANCE This is the first report to date of the use of MIOCTA in the operating room for young children with retinal vascular disease. Further optimization of this system may allow noninvasive detailed evaluation of retinal vasculature during surgical procedures and in patients who ...

What Is the Impact of Intraoperative Microscope-Integrated OCT in Ophthalmic Surgery? Relevant Applications and Outcomes. A Systematic Review

“…Thanks to swept-source technology, another experimental MI-OCT system was able to perform intraoperative optical coherence tomography angiography in two children with retinal vascular diseases. It allowed for detailed analysis of vascular pattern comparted to fluorescein angiography, visualizing small pathological retinal vessels usually obscured by fluorescein staining due to pre-existing laser scars [ 129 ].…”

Visualizing Macular Microvasculature Anomalies in 2 Infants With Treated Retinopathy of Prematurity

“…The advent of supine retinal imaging and OCT-A has allowed visualization of vascular details not seen on traditional table-top imaging 2,6 . The findings in this report may guide future research of human retinal vascular development, and alert us to macular changes in infants with ROP.…”

Macular Microvascular Findings in Familial Exudative Vitreoretinopathy on Optical Coherence Tomography Angiography

“…This is, to our knowledge, the first case series of depth-resolved macular imaging in FEVR and revealed abnormalities of both the superficial and deep vascular plexuses. Although there has been one report of OCT-A in a patient with FEVR 24 , these microvascular abnormalities were not otherwise evident on FA and not previously described (PubMed Search on June 11, 2018: "familial exudative vitreoretinopathy" AND "fluorescein angiography"; "familial exudative vitreoretinopathy" AND "optical coherence tomography angiography"). In the 7 eyes with vascular abnormalities, imaging of the SVC revealed increased vessel dilation, presence of vascular curls and loops, and straightening of the macular vasculature, and imaging of the DVC revealed disorganized vascular pattern with stub-like vessel terminations.…”