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Michael I Seider, Oscar Carrasco-Zevallos, Brenton Keller, Joseph A Izatt, Cynthia A Toth, Christian Viehland; Real-Time Swept-Source Microscope-Integrated versus Hand-Held Spectral-Domain Optical Coherence Tomography during Macular Hole Surgery. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4084.
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To compare the clinical utility of a novel real-time swept-source microscope-integrated optical coherence tomography (SS-MIOCT) system to hand-held spectral-domain OCT (HH-OCT) during macular hole repair.
All patients undergoing macular hole repair from 9/1/2014 - 10/31/2014 at the Duke Eye Center by a senior Vitreoretinal Surgeon (CT) who gave consent were included. During macular surgery, SS-MIOCT was used for all patients and allowed real-time imaging through the operating microscope. The system has acquisition and processing rates of 2-10 volumes per second and permitted the creation of volumetric renderings of surgical maneuvers over time.<br /> HH-OCT (Bioptigen Inc., Morrisville, NC, USA) was also performed in the operating room at pauses in surgery immediately before and at the completion of macular surgery. The images produced by both systems were compared post-operatively.
<br /> Five female and 1 male patient with average age 70 years were included, contributing three right and three left eyes in total.<br /> SS-MIOCT was able to obtain high-quality, volumetric renderings of surgical maneuvers in real-time without causing an interruption in surgery. Particularly striking images documented instruments brushing the retinal surface and forceps peeling internal limiting membrane (ILM). SS-MIOCT scans allowed for the characterization of anatomy-instrument relationships such as the distance of an instrument from the retinal surface, the retinal deformation created during scraping and the characteristics of elevated membranes volumetrically and over time.<br /> Hand-held OCT produced high-resolution two-dimensional scans at pauses during surgery. These images allowed for the accurate characterization of the morphology of the macular holes before and after ILM peeling, and the confirmation of removal of epiretinal membranes. For the cases of ILM autografting, HH-OCT created useful images confirming the location of the autograft over the macular hole.
SS-MIOCT appears to have significant advantages over HH-OCT during macular hole surgery. SS-MIOCT was able to capture volumetric scans of surgical maneuvers in real-time without interrupting surgery whereas HH-OCT was useful for obtaining high-quality static images of retinal anatomy during breaks in surgery.
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