Abstract
Purpose:
A retrospective, single-center, case-series was initiated to evaluate the first clinical experience with the first commercially available intraoperative optical coherence tomography system (iOCT) for the enhancement of ophthalmic surgery.
Methods:
The Rescan 700 system (Zeiss, Oberkochen, Germany), a spectral-domain OCT system integrated into a Lumera 700 surgical-microscope (Zeiss, Oberkochen, Germany), was used in 40 consecutive cases. A standardized review was used to assess whether the iOCT-imaging resulted in additional information or/and altered decision-making. Additionally, the preoperative diagnosis, surgical procedures and total iOCT-imaging time were documented to analyze potentially increased surgery time.
Results:
For anterior and posterior segment surgical procedures, iOCT-imaging was found to be beneficial.<br /> The surgeons in this study reported that iOCT-imaging provided additional information in 74.1% of the posterior and combined surgical cases (n=31), which resulted in 41.9% of the cases in altered decision-making. The iOCT imaging time amounted on average to 167 seconds (SD =77 seconds). In addition, it showed to be usable in conjunction with common chromovitrectomy-dyes and different tamponades. Furthermore, iOCT-imaging allowed evaluation of iatrogenic effects during surgery and subsequent minimization.<br /> In anterior procedures (n=9), the surgeons reported gain of additional information in 22.2% of all cases and no case of altered decision-making. In these procedures, the iOCT imaging time amounted on average to 117 seconds. Among others, the following aspects were evaluated: corneal incisions with regard to size, positioning and extension; anterior capsular rhexis; hydrodisection with imaging of the posterior capsule; phacoemulsification and incision closure by hydration.<br /> Novel intraoperative-alterations of the macula, peripheral retina and sclera, which can only be seen on iOCT, were discovered, described and evaluated.
Conclusions:
The Rescan 700 system fits into the surgical process and allows intraoperative life-scanning to evaluate different ocular structures for surgical decision making. The here shown results suggest that iOCT has the potential to improve the quality of posterior and anterior segment surgery.