June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Visualization from microscope-integrated swept-source OCT in vitreoretinal surgery for diabetic tractional retinal detachment
Author Affiliations & Notes
  • Hesham Gabr
    Ophthalmology, Duke University, Durham, North Carolina, United States
    Ophthalmology, Ain-Shams University, Cairo, Egypt
  • Xi Chen
    Ophthalmology, Duke University, Durham, North Carolina, United States
  • Tamer H Mahmoud
    Ophthalmology, Duke University, Durham, North Carolina, United States
  • Lejla Vajzovic
    Ophthalmology, Duke University, Durham, North Carolina, United States
  • S. Tammy Hsu
    Ophthalmology, Duke University, Durham, North Carolina, United States
  • Alexandria Dandridge
    Ophthalmology, Duke University, Durham, North Carolina, United States
  • Karim Sleiman
    Ophthalmology, Duke University, Durham, North Carolina, United States
  • Oscar Carrasco-Zevallos
    Biomedical Engineering, Duke University, Durham, North Carolina, United States
  • Christian Viehland
    Biomedical Engineering, Duke University, Durham, North Carolina, United States
  • Joseph A Izatt
    Biomedical Engineering, Duke University, Durham, North Carolina, United States
  • Cynthia A Toth
    Ophthalmology, Duke University, Durham, North Carolina, United States
    Biomedical Engineering, Duke University, Durham, North Carolina, United States
  • Footnotes
    Commercial Relationships   Hesham Gabr, None; Xi Chen, Bayer (F); Tamer Mahmoud, Alcon (R), Alimera (C), Dorc (C), Genentech (R), Spark Therapeutics (C); Lejla Vajzovic, Alcon (F), Janssen Pharmaceutical (R), Knights Templar Eye Foundation (R), PDC'S ENABLE Award (R), Roche (F), Second Sight (F); S. Tammy Hsu, None; Alexandria Dandridge, None; Karim Sleiman, None; Oscar Carrasco-Zevallos, None; Christian Viehland, None; Joseph Izatt, Leica Microsystems (P), Leica Microsystems (R); Cynthia Toth, Alcon Laboratories (P), Genentech (F)
  • Footnotes
    Support  NIH-R01EY023039
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 3777. doi:
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      Hesham Gabr, Xi Chen, Tamer H Mahmoud, Lejla Vajzovic, S. Tammy Hsu, Alexandria Dandridge, Karim Sleiman, Oscar Carrasco-Zevallos, Christian Viehland, Joseph A Izatt, Cynthia A Toth; Visualization from microscope-integrated swept-source OCT in vitreoretinal surgery for diabetic tractional retinal detachment. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3777.

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

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Abstract

Purpose : Two dimensional (2D) intraoperative spectral-domain OCT has been used to identify surgical planes during membrane delamination in diabetic tractional retinal detachment (DTRD) surgery. We evaluated the potential utility of live volumetric (4D) intraoperative swept-source microscope-integrated OCT (SS-MIOCT) in DTRD surgery.

Methods : In this retrospective study, cases with DTRD were imaged under IRB approved prospective protocol using SS-MIOCT capable of producing live volumetric (4D) imaging during surgical maneuvers. In near real time, images were displayed in stereo heads-up display with surgeon-controlled volume rotation via a joystick facilitating intraoperative image analysis and surgeon feedback. Postoperative review included scoring image quality, identifying DTRD-related pathologies and tracking surgical maneuvers. Image quality was scored as “good” if the detached retina could be distinguished from overlying fibrovascular membrane in 2D and 4D images.

Results : Good quality 4D visualization from SS-MIOCT was obtained in 12/16 eyes (75%). Identification of DTRD-related pathologies was feasible in 9 eyes. These included: retinoschisis (Fig. 1), intraretinal versus subretinal fluid, focally versus broadly adherent membranes, intraretinal cysts before and after membrane peeling and laser treatment scars that showed adhesions bridging choroid to detached retina. In review, one could view interaction between instruments and fibrovascular membranes and confirm separation of membranes from retinal tissues during delamination (Fig. 2). In 2 cases, delamination required viscodissection, achieved by creating a hole in the fibrovascular membrane and injecting viscoelastic. In one of these cases, SS-MIOCT differentiated between an initial partial thickness hole created in the membrane versus a full thickness hole, facilitating successful viscodissection. A limitation of SS-MIOCT was the depth of field and challenge to rapidly shift the focus. This resulted in poor quality images in 4/16 eyes (25%) due to high DTRD elevation.

Conclusions : SS-MIOCT can provide important guidance during complex vitreoretinal surgery for DTRD. Further advances are needed for wider application of this technology.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

Fig. 1: Retinoschisis.

Fig. 1: Retinoschisis.

 

Fig. 2: Membrane delamination. A) En face view. B) B-scan. C) and D) Volume rotation with 3D image from 2 different angles. (*): Fibrovascular membrane.

Fig. 2: Membrane delamination. A) En face view. B) B-scan. C) and D) Volume rotation with 3D image from 2 different angles. (*): Fibrovascular membrane.

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