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Justis P Ehlers, Sunil K Srivastava, Yuji Itoh, Yuankai K Tao; Integrative Surgical Instrument Solutions for Optimizing Intraoperative OCT for Ophthalmic Surgery. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2336.
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Previous studies have also demonstrated the limitations of conventional metallic instruments for OCT-based visualization (e.g., shadowing of underlying tissue, poor instrument identification). Optimal integration into the surgical environment will require significant advances in surgical instrumentation to optimize OCT-based visualization of maneuvers utilizing a microscope integrated OCT (MIOCT) system. The purpose of this study was to assess novel surgical instrumentation prototypes specifically designed for use with a MIOCT system to assess OCT-based visualization of instrument-tissue interactions.
CT-compatible instrumentation, including vitreoretinal forceps and surgical picks, were prototyped based on optimal material properties for OCT transparency and contrast. MIOCT imaging was performed in fresh cadaveric porcine eyes using a second-generation MIOCT prototype system with enhanced ergonomic/functional features (FIGURE 1). Volumetric imaging and real-time OCT-based motion capture using custom imaging acquisition protocols were used for instrument/tissue visualization at numerous locations, including mid-vitreous and retinal surface.
High-resolution MIOCT images allowed prototype instrument visualization at all locations. OCT-compatible surgical instruments exhibited excellent optical properties, including minimal shadowing and optimal light scattering. Minimizing shadowing provided outstanding views of the underlying tissue, increasing the capacity for instrument-tissue interaction visualization (FIGURE 2). The light scattering properties provided for excellent B-scan resolution of the instrument tip, compared to specular reflection artifacts often seen with metallic instruments. Motion capture and volumetric OCT scans were successfully obtained during surgical maneuvers.
Enhanced visualization of instrument/tissue interactions is possible utilizing a second generation MIOCT system in combination with OCT-friendly instrumentation. This represents an important achievement for improved integration of intraoperative OCT and the potential to fully integrate this technology into the ophthalmic operating room.
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