The Use of Optical Coherence Tomography in Intraoperative Ophthalmic Imaging

Abstract

Optical coherence tomography (OCT) has transformed diagnostic ophthalmic imaging but until recently has been limited to the clinic setting. The development of spectral-domain OCT (SD-OCT), with its improved speed and resolution, along with the development of a handheld OCT scanner, enabled portable imaging of patients unable to sit in a conventional tabletop scanner. This handheld SD-OCT unit has proven useful in examinations under anesthesia and, more recently, in intraoperative imaging of preoperative and postoperative manipulations. Recently, several groups have pioneered the development of novel OCT modalities, such as microscope-mounted OCT systems. Although still immature, the development of these systems is directed toward real-time imaging of surgical maneuvers in the intraoperative setting. This article reviews intraoperative imaging of the posterior and anterior segment using the handheld SD-OCT and recent advances toward real-time microscope-mounted intrasurgical imaging.

Miniature real-time intraoperative forward-imaging optical coherence tomography probe

“…External OCT has limitations in that metallic surgical instruments cast dense optical shadows upon the underlying tissues of interest [27][28][29]31]. In addition, a major limitation is the ability to efficiently locate and follow the surgical instrument as the membrane peeling or other procedure occurs [27][28][29]. Finally, optical aberrations of the media will reduce clarity of the externally acquired OCT image [5].…”

“…The value of OCT imaging in the ophthalmic operating room has been demonstrated with an external system in evaluating the changes of the retinal structures immediately following surgical manipulation [27][28][29][30][31][32][33]. This would ensure that the intended procedure has been completed as desired.…”

“…However, it would be most desirable to use real-time intraoperative OCT to improve efficiency and completeness interactively during a procedure, such as during membrane peeling, by aiding visualization of the actual surgical maneuvers as they occur. External OCT has limitations in that metallic surgical instruments cast dense optical shadows upon the underlying tissues of interest [27][28][29]31]. In addition, a major limitation is the ability to efficiently locate and follow the surgical instrument as the membrane peeling or other procedure occurs [27][28][29].…”

Intraoperative optical coherence tomography: past, present, and future

“…[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.…”

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

“…Intraoperative OCT (iOCT) has recently been introduced by several research groups, [1][2][3][4] and has been reported to be useful in vitreoretinal, [5][6][7][8] anterior segment, [9][10][11] and glaucoma surgery. 12 In Europe and in the United States, microscopeintegrated iOCT units are commercially available from two different manufacturers.…”