Heads-up ocular microsurgery with integrated live volumetric intraoperative optical coherence tomography

Abstract

Purpose : To demonstrate the utility of incorporation of intraoperative Swept Source-Microscope Integrated OCT (SS-MIOCT) into the 3D heads-up surgery system (NGENUITY®) during ocular surgery.

Methods : This is a retrospective study on the use of the assimilated NGENUITY® with the SS-MIOCT during anterior and posterior segment surgeries. Eight patients were enrolled. Five patients underwent pars plana vitrectomy for retinal detachment (3 cases), macular hole (1 case) and epiretinal membrane (1 case). The other 3 patients underwent Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).
Images obtained with the NGENUITY® and the SS-MIOCT ( B-scan and live 3D OCT images) were displayed concurrently on the same 3D 4K screen. Surgeon feedback was documented intraoperatively. Feedback included comments on image quality, visualization benefits and challenges. Postoperative analysis included evaluation of surgical and OCT image quality and review of intraoperatively documented surgeon’s feedback.

Results : The SS-MIOCT was successfully integrated into the NGENUITY® in all 8 cases. The concurrent B-scan and 3D OCT view was useful for detecting residual subretinal fluid, edges of macular holes during ILM peeling, confirming graft attachment in DSAEK (Fig.1) and for live volumetric OCT visualization of instrument-tissue interaction (Fig.2).

Conclusions : The integration of the 3D heads-up surgery with SS-MIOCT could be an ideal interface for both surgical view and OCT view for tissue microanatomy. The display of the OCT data along with the surgical view on the large 4K monitor can provide excellent visualization of OCT images while maintaining the surgeon’s attention on the surgical field.

This is a 2021 ARVO Annual Meeting abstract.

 

Fig.1 . B-scan and 3D intraoperative OCT imaging of corneal graft implantation in Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Right half: surgical view. Left half: 3D OCT scan (top left) and B-scan (bottom left) show no space between the host cornea and the graft confirming graft attachment (arrows).

 

Fig.2. Instrument-tissue interaction in a case of macular hole. Right half: surgical view shows a flex loop tool directed towards the surface of retina for internal limiting membrane peeling. Top left: 3D view shows the ring of the flex loop (arrow) as it gets closer to the retina. Bottom left: B-scan shows a section of the ring of the flex loop (arrow) at the deepest point before interacting with retina.