June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
A smart vitrector equipped by a fiber-based OCT sensor mitigates simulated iatrogenic retinal injuries during vitrectomy in pigs
Author Affiliations & Notes
  • Christos Boutopoulos
    Universite de Montreal, Montreal, Quebec, Canada
    Hopital Maisonneuve-Rosemont Centre de Recherche, Montreal, Quebec, Canada
  • Alexandre Abid
    Universite de Montreal, Montreal, Quebec, Canada
    Hopital Maisonneuve-Rosemont Centre de Recherche, Montreal, Quebec, Canada
  • Flavio Rezende
    Universite de Montreal, Montreal, Quebec, Canada
    Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Renaud Duval
    Universite de Montreal, Montreal, Quebec, Canada
    Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Footnotes
    Commercial Relationships   Christos Boutopoulos, United States Provisional Patent Application No. 63/109,040, (P); Alexandre Abid, United States Provisional Patent Application No. 63/109,040, (P); Flavio Rezende, United States Provisional Patent Application No. 63/109,040, (P); Renaud Duval, United States Provisional Patent Application No. 63/109,040, (P)
  • Footnotes
    Support  Fonds de la Recherche en Santé du Québec (FRSQ) (253123 and 265459); Fonds de recherche en ophtalmologie de l’Université de Montréal (Concours 2017-2018)
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 3652. doi:
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    • Get Citation

      Christos Boutopoulos, Alexandre Abid, Flavio Rezende, Renaud Duval; A smart vitrector equipped by a fiber-based OCT sensor mitigates simulated iatrogenic retinal injuries during vitrectomy in pigs. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3652.

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

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Abstract

Purpose : The occurrence of iatrogenic retinal breaks (IRB) in pars plana vitrectomy (PPV) is a complication that compromises the overall efficacy of the surgery. A subset of IRB occurs when the retina (rather than the vitreous gel) is cut accidentally by the vitrector. We hypothesise the a smart vitrector, equipped by a fiber-based optical coherence tomography (OCT) sensor, can detect intraoperatively the onset of IRB and activate promptly a PPV machine response to prevent them. We developed such a system and performed PPV on pigs to validate it.

Methods : We fabricated the smart vitrectors by attaching a miniaturised fiber-based OCT sensor (125 μm in diameter) on commercial vitrectors (25G). The OCT sensor was appropriately positioned to detect undesirable retina displacement towards the vitrector orifice (i.e., IRB onset). The smart vitrector was connected to a commercial vitrectomy machine as in standard PPV. We used a customized OCT machine and a built-in algorithm to process the intraoperative signal. The system response time to an IRB onset was measured and compared to that of the average surgeon. Finally, two surgeons validated its ability to prevent simulated IRB (i.e., vitrector manipulations aiming to “bite” attached or detached retina) by performing PPV in 2 two pigs. Note that the system requires no signal interpretation by the surgeons.

Results : We found that the response time of the system (28.9 ± 6.5 ms) is 12-times faster compared to that reported for intraocular maneuvers performed by surgeons (p < 0.0001). We show that an additional 2-times improvement can be attained with minor technical modifications that require proprietary access to the vitrectomy machine that was used. Ex-vivo validation (porcine eyes) showed that the system prevents 78.95% (15/19) (95% CI: 54.43 – 93.95) of simulated IRB, while in-vivo validation showed that the system prevents or mitigates 70.37% (38/54) (95% CI: 56.39 – 82.02) of simulated IRB.

Conclusions : Our results are consisted with the hypothesis that an OCT – sensor attached to the vitrector can prevent IRB by providing intraoperative feedback to the PPV machine. Importantly, the use of the smart vitrector with its safety mechanism requires no modifications of the established PPV procedure. It can mitigate a significant proportion of IRB and thus improve the overall efficacy of the surgery.

This is a 2021 ARVO Annual Meeting abstract.

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