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S. Binder, C. I. Falkner-Radler, C. Hauger, H. Matz, C. G. Glittenberg; Clinical Applications of Intrasurgical SD-Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2010;51(13):268.
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To evaluate the clinical applications of a combination of an intra-operative spectral domain optical coherence tomography (SD-OCT) connected with the surgical microscope.
Using a Carl Zeiss MeditecTM Cirrus HD-OCTTM which is adapted to the optical pathway of a Zeiss OPMI VISU 200TM surgical microscope, 512x128 macular cube scans were performed at various steps of vitreoretinal surgery and cataract surgery. The acquired volume data was post processed and visualized using a ray-traced three dimensional display system created in the C++ based object oriented programming language COFFEE (Maxon Inc.TM). Informed consent had been collected from all patients.
39 512x128 macular cube scans of 30 patients (30 eyes) were acquired. The surgical procedures included 21 pars plana vitrectomies with membrane peeling with or without cataract surgery and implantation of a posterior chamber lens (15). Indication for surgery was preretinal membrane formation in 13 cases and macular hole in 8 cases. 3 eyes underwent retinal detachment repair surgery and 6 eyes had cataract surgery only. It was possible to acquire intra retinal scans with sufficient quality from all patients (pre- intra -and post surgically). Decisions for additional membrane peeling if incomplete, knowledge about the behavior of the macular hole immediately after ILM removal, maintenance of the foveal depression during membrane peeling, information about invisible fluid accumulation under silicone in a supine position or a clinically diagnosed "macula on" retinal detachment and the behavior of the fovea immediately after cataract removal could be gained by using the intraoperative OCT. Improvements in the technology to facilitate its use and the incorporation of a tracking system are needed.
Intra-surgical SD-OCT evaluation does offer additional information to the surgeon.
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