Three Dimensional Digitally-Enabled Intraoperative OCT Compared with Conventional Microscope-Integrated Intraoperative OCT in Vitreoretinal Surgery: A Post Hoc Analysis of the DISCOVER Study

Abstract

Purpose : New digitally-enabled options for high-definition, heads-up stereoscopic visualization during surgery recently became available for an immersive 3D visualization of both the surgical field and the intraoperative OCT (iOCT) datastream. The purpose of this study was to compare conventional microscope-integrated iOCT and digitally-enabled microscope-integrated iOCT surgical platform.

Methods : This was a post-hoc case-control analysis from the DISCOVER study, a prospective, IRB-approved multi-surgeon case series, comparing the use of a conventional microscope-integrated iOCT (Rescan 700; Zeiss, Germany) with a digitally-enabled iOCT (Artevo 800; Zeiss). The two groups were optimally matched for surgeon and preoperative diagnosis. Standardized surgeon questionnaires were collected immediately following surgery. The primary objective was comparative assessment of surgical visualization efficiency [i.e., proportion of surgical field-based visualization (i.e., ocular heads-up display in the conventional group, 3D screen-based visualization in the digitally-enabled group) and non-surgical field-based (e.g., external 2-D monitor)]. Additional variables of comparison included iOCT utility and impact of iOCT on surgical decisions.

Results : 200 eyes from 200 subjects were included with 100 subjects in each arm. The most common indications for surgery were epiretinal membrane (conventional iOCT = 35%; digital iOCT = 33%) followed by retinal detachment and macular holes (conventional iOCT = 21%, 19%; digital iOCT = 21%, 20%, respectively). Surgical field-based visualization of iOCT datastream was significantly higher in the digitally-enabled group compared with conventional iOCT group (88% vs 7%, p <0.0001). Surgeon-perceived utility of iOCT was similar between groups (conventional iOCT = 53%; digital iOCT = 60%, p = 0.32). The direct impact of iOCT on surgical decision-making was also similar between both groups (16% vs 21%, p=0.36).

Conclusions : Digitally-enabled microscope-integrated iOCT resulted in greater surgical visualization efficiency with a significantly higher proportion of cases with surgical-field based visualization of the iOCT datastream compared to the conventional system. Surgeon-perceived utility of iOCT was high in both groups.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.