June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
4D Intrasurgical Monitoring and Guidance of Anterior Segment Surgeries with Swept-Source Microscope Integrated Optical Coherence Tomography
Author Affiliations & Notes
  • Neel Dave Pasricha
    Ophthalmology, Duke University School of Medicine, Durham, NC
  • Christine Shieh
    Ophthalmology, Duke University School of Medicine, Durham, NC
  • Oscar Carrasco-Zevallos
    Biomedical Engineering, Duke University, Durham, NC
  • Brenton Keller
    Biomedical Engineering, Duke University, Durham, NC
  • Melissa Daluvoy
    Ophthalmology, Duke University School of Medicine, Durham, NC
  • Joseph A Izatt
    Ophthalmology, Duke University School of Medicine, Durham, NC
    Biomedical Engineering, Duke University, Durham, NC
  • Cynthia A Toth
    Ophthalmology, Duke University School of Medicine, Durham, NC
    Biomedical Engineering, Duke University, Durham, NC
  • Anthony N Kuo
    Ophthalmology, Duke University School of Medicine, Durham, NC
  • Footnotes
    Commercial Relationships Neel Pasricha, None; Christine Shieh, None; Oscar Carrasco-Zevallos, None; Brenton Keller, None; Melissa Daluvoy, None; Joseph Izatt, Bioptigen (I), Bioptigen (P), Bioptigen (S); Cynthia Toth, Bioptigen (F), Duke University (P), Genentech (F), Physical Sciences (F); Anthony Kuo, Bioptigen (P)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 3974. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Neel Dave Pasricha, Christine Shieh, Oscar Carrasco-Zevallos, Brenton Keller, Melissa Daluvoy, Joseph A Izatt, Cynthia A Toth, Anthony N Kuo; 4D Intrasurgical Monitoring and Guidance of Anterior Segment Surgeries with Swept-Source Microscope Integrated Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3974.

      Download citation file:


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

      ×
  • Supplements
Abstract
 
Purpose
 

Spectral-domain microscope integrated optical coherence tomography (MIOCT) systems allow 2D visualization of a few locations during surgery. This requires that the B-scan be repeatedly matched to the region or tool of interest. Imaging the entire spatial extent of the surgical field (3D) would allow the surgeon to monitor the entire field in real time without constraints imposed by single B-scan imaging. The purpose of this study was to dynamically image and guide anterior segment surgical maneuvers in 4D (3D + time) using swept-source MIOCT (SS-MIOCT).

 
Methods
 

Under an IRB approved protocol, 5 patients undergoing anterior segment surgeries - 2 cataracts, 2 deep anterior lamellar keratoplasties (DALK), and 1 Descemet’s stripping automated endothelial keratoplasty (DSAEK) triple - consented to allow use of intrasurgical OCT. SS-MIOCT with custom tracking hardware and a swept-frequency source centered at 1040 nm were used for imaging (A-scan rate: 100 kHz, volume rate: 2 Hz, 102 dB sensitivity, 12x12x7.4 mm imaging range). Volumetric processing was performed and displayed in real-time. Surgeries were performed per surgeons’ standard technique complemented by feedback from OCT images.

 
Results
 

All intended 4D tissue-tool interactions were successfully monitored (Figures 1 and 2). Specific surgical maneuvers were actively guided by OCT. These included dynamic wound testing at the conclusion of cataract surgery, guiding needle placement during DALK, and assessment of graft-host interface fluid during DSAEK.

 
Conclusions
 

SS-MIOCT was used to dynamically monitor and guide specific anterior segment surgical maneuvers. However, surgical maneuvers exceeding the axial and lateral imaging range of the system (instrument motions carrying the eye out of field) did affect the ability to image some maneuvers. Further development of SS-MIOCT 4D imaging during anterior segment surgeries will elucidate its role for improving surgical guidance and ultimately clinical outcomes.  

 
Figure 1: A) 3D, B) B-scan, and C) summed-voxel projection (SVP) images are shown in time sequence for graft unfolding during DSAEK (red: cornea, yellow: graft, blue: iris).
 
Figure 1: A) 3D, B) B-scan, and C) summed-voxel projection (SVP) images are shown in time sequence for graft unfolding during DSAEK (red: cornea, yellow: graft, blue: iris).
 
 
Figure 2: A) 3D and B-scan images for wound testing at the conclusion of cataract surgery (red: Weck-Cel, yellow: incision, *: artifact). B) 3D and B-scan images for needle depth guidance during DALK (blue: needle).
 
Figure 2: A) 3D and B-scan images for wound testing at the conclusion of cataract surgery (red: Weck-Cel, yellow: incision, *: artifact). B) 3D and B-scan images for needle depth guidance during DALK (blue: needle).

 
×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×