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Paul Hahn, Justin Migacz, Rachelle O'Connell, Eric Yuan, Tomas A. Moreno, Joseph A. Izatt, Cynthia A. Toth; Initial Experience With Human Imaging Of Vitreoretinal Surgical Maneuvers Using A Custom Microscope-Mounted Spectral Domain Optical Coherence Device. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3115.
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© ARVO (1962-2015); The Authors (2016-present)
We have recently developed a microscope-mounted optical coherence tomography (MMOCT) device designed to enable spectral domain OCT image acquisition simultaneous with surgical maneuvers. Prior to this report, MMOCT had been tested in model eyes only. The purpose of the current study is to report the translation of MMOCT into human imaging with characterization and assessment of retinal images obtained in human patients undergoing surgery.
Before proceeding with human imaging, quantitative rating of MMOCT was performed by multiple surgeons and scrub nurses under fully simulated surgical conditions in model eyes. Acceptable pre-clinical evaluation was required prior to human imaging. Under an IRB-approved protocol, MMOCT was then assessed for its ability to obtain images in human surgical patients in the operating room. Retinal images were obtained with instruments removed from the operative eye, with instruments safely positioned in the mid-vitreous cavity, and with instruments performing surgical maneuvers. Images obtained with MMOCT were compared to those at a similar time point obtained with the Bioptigen handheld OCT (HHOCT). Comparable imaging with MMOCT was defined as 80% correlation in identification of pathology compared to HHOCT.
MMOCT under simulated surgical conditions was favorably evaluated by surgeons and scrub nurses, all of whom reported they would consider participating in human trials. Quantitative pre-clinical MMOCT rating met requirements to proceed with human imaging. Intraoperative human retinal imaging was successfully obtained without instruments in the eye, with instruments suspended in the mid-vitreous cavity, and during surgical manipulations. MMOCT revealed surgery-induced anatomical alterations of the retina, including a flap of residual internal limiting membrane following peel, presence of subfoveal fluid following macular hole repair, and relief of traction during epiretinal membrane removal. Identification of pathology using MMOCT was comparable to that with HHOCT.
This report is the first demonstration of MMOCT imaging in human eyes during surgery. Further refinements of this system will be directed towards fully integrating the MMOCT device with vitreoretinal and other ocular surgery.
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