September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
4D Microscope-Integrated OCT to Visualize Depth-Related Steps During Anterior Segment and External Eye Procedures
Author Affiliations & Notes
  • Paramjit K Bhullar
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Neel D Pasricha
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Oscar M Zevallos-Carrasco
    Biomedical Engineering, Duke University , Durham, North Carolina, United States
  • Christian Viehland
    Biomedical Engineering, Duke University , Durham, North Carolina, United States
  • Brenton Keller
    Biomedical Engineering, Duke University , Durham, North Carolina, United States
  • Melissa B Daluvoy
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Pratap Challa
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Sharon F Freedman
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Joseph A Izatt
    Biomedical Engineering, Duke University , Durham, North Carolina, United States
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Cynthia A Toth
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
    Biomedical Engineering, Duke University , Durham, North Carolina, United States
  • Anthony N Kuo
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Footnotes
    Commercial Relationships   Paramjit Bhullar, None; Neel Pasricha, None; Oscar Zevallos-Carrasco, None; Christian Viehland, None; Brenton Keller, None; Melissa Daluvoy, None; Pratap Challa, None; Sharon Freedman, None; Joseph Izatt , Bioptigen (I), Bioptigen (P), Bioptigen (S); Cynthia Toth, Alcon (F), Bioptigen (F), Duke University (P), Genentech (F), ThromboGenics (C); Anthony Kuo, Bioptigen (P)
  • Footnotes
    Support  National Institutes of Health Bioengineering Research Partnership Grant R01-EY023039, National Institutes of Health R01-EY024312, and unrestricted grant from Research to Prevent Blindness to the Department of Ophthalmology at Duke University School of Medicine
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 467. doi:
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      Paramjit K Bhullar, Neel D Pasricha, Oscar M Zevallos-Carrasco, Christian Viehland, Brenton Keller, Melissa B Daluvoy, Pratap Challa, Sharon F Freedman, Joseph A Izatt, Cynthia A Toth, Anthony N Kuo; 4D Microscope-Integrated OCT to Visualize Depth-Related Steps During Anterior Segment and External Eye Procedures. Invest. Ophthalmol. Vis. Sci. 2016;57(12):467.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Several ophthalmic surgical procedures require accurate assessment of instrument depth, which can be challenging from a standard top-down view of the surgical field. Using live intraoperative 4D (3D across time) swept-source microscope-integrated optical coherence tomography (SS-MIOCT), we demonstrate direct visualization of depth-related steps in glaucoma, strabismus, and corneal surgeries.

Methods : Six subjects undergoing tube shunt placement, trabeculectomy, iStent placement, lateral rectus resection, Descemet’s stripping automated endothelial keratoplasty (DSAEK), and deep anterior lamellar keratoplasty (DALK) were consented under a Duke IRB approved protocol. A 100kHz SS-MIOCT system with a volume rate of 2Hz was used to visualize key depth related steps intraoperatively, in real-time.

Results : SS-MIOCT provided surgeons with live guidance and visualized scleral tunneling, tube shunt positioning in the anterior chamber (AC), and suturing during tube shunt placement; scleral flap creation, sclerotomy, and iridectomy during trabeculectomy; positioning of stent in area of Schlemm’s canal during iStent placement; needle depth during muscle and scleral passes during strabismus surgery; fluid between graft and native cornea during DSAEK; and needle depth in cornea prior to air injection during DALK. Select images are shown in Fig. 1.

Conclusions : Assessment of instrument depth in the AC, sclera, muscle, and cornea can be challenging during ophthalmic procedures, but is important in avoiding complications such as inadequate reductions in intraocular pressure due to suboptimal positioning of drainage devices, muscle slipping and scleral perforation during strabismus surgery, non-adherence of the donor and native corneas during DSAEK, and unsuccessful big-bubble formation during DALK. SS-MIOCT allows for visual guidance of depth-based steps in real-time, making it a valuable tool for ophthalmic surgeons.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

SS-MIOCT volumetric (left, with manual false coloring) and B-scan (right) pairs showing (A) tube (green arrows) during tube shunt placement and (B) needle (green arrow) depth in sclera during strabismus surgery.

SS-MIOCT volumetric (left, with manual false coloring) and B-scan (right) pairs showing (A) tube (green arrows) during tube shunt placement and (B) needle (green arrow) depth in sclera during strabismus surgery.

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