Purchase this article with an account.
Oscar Carrasco-Zevallos, Brenton Keller, Christian Viehland, Liangbo Shen, Gar Waterman, Crystal Chukwurah, Paul Hahn, Anthony N Kuo, Cynthia A Toth, Joseph A Izatt; Real-time 4D Stereoscopic Visualization of Human Ophthalmic Surgery with Swept-Source Microscope Integrated Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4085.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Ophthalmic surgery is performed with a microscope that provides limited depth perception. Surgeons often rely on indirect cues for depth information. Current intraoperative Spectral-Domain OCT systems are limited to cross-sectional real-time imaging. Ophthalmic surgery is performed in a 3D surgical field; therefore, a real-time 3D micron-scale imaging modality could be useful for surgical feedback and guidance. We report on the development of 4D (volumetric imaging + time) Microscope Integrated OCT (4D MIOCT) for real-time volumetric visualization of human ophthalmic surgery.
The MIOCT sample arm enabled concurrent OCT and operating microscope imaging. The system employed a custom swept-source OCT engine operating at 1060 nm. GPU-based custom software enabled real-time acquisition, processing, and rendering of volumetric images at 100k A-lines/second. Volumetric frame rates varied between 2-10 Hz. A custom microscope integrated stereoscopic heads-up display (HUD) allowed for visualization of MIOCT volumes through the surgical binoculars. 4D MIOCT imaging was performed in 25 human surgeries (7 anterior segment, 18 vitreoretinal). Vitreoretinal cases imaged included macular hole, retinal detachment, and epi-retinal membrane (ERM) procedures. Anterior segment cases imaged included cataract, deep anterior lamellar keratoplasty, and Descemet stripping endothelial keratoplasty procedures.
Figure 1 shows 4D MIOCT imaging of an ERM peel with surgical forceps during a macular hole surgical case. The time stamps for each volume in the time series are in seconds. B-scans are shown below each corresponding volume. The location of the B-scans is denoted by the white rectangle on the volume view. Surgical camera frames are shown as well with a yellow rectangle denoting the MIOCT field of view. Figure 2 illustrates 4D MIOCT imaging of a cataract case. A-B depict volumes and B-scans acquired at different stages of cataract surgery. (A) shows the intact cataract. (B) shows cataract fragmentation with a phacoemulsification needle (red arrow). (C) shows the anterior segment after cataract removal. (D) shows intraocular lens (green arrow) insertion.
Real-time, volumetric, micron-scale visualization of human ophthalmic surgery was performed with 4D MIOCT.
This PDF is available to Subscribers Only