June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Optical Coherence Tomography Navigated Laser Retinopexy for Retinal Breaks
Author Affiliations & Notes
  • Simon Salzmann
    HuCE optoLab, Berner Fachhochschule, Biel, Switzerland
  • Christian Burri
    HuCE optoLab, Berner Fachhochschule, Biel, Switzerland
    Institute of Applied Physics – Biomedical Photonics Group, Universitat Bern, Bern, Switzerland
  • Sami Al-Nawaiseh
    Department of Ophthalmology, Universitatsklinikum Munster, Munster, Germany
  • Philip Wakili
    Eye Clinic Sulzbach, Knappschaftsklinikum Saar GmbH Krankenhaus Sulzbach, Sulzbach, Germany
  • Christoph Meier
    HuCE optoLab, Berner Fachhochschule, Biel, Switzerland
  • Footnotes
    Commercial Relationships   Simon Salzmann Heidelberg Engineering, Meridian Medical, Code F (Financial Support), Heidelberg Engineering, Meridian Medical, Haag-Streit, Code R (Recipient); Christian Burri Heidelberg Engineering, Meridian Medical, Code F (Financial Support), Heidelberg Engineering, Meridian Medical, Haag-Streit, Code R (Recipient); Sami Al-Nawaiseh Heidelberg Engineering, Code R (Recipient); Philip Wakili None; Christoph Meier None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3793 – F0214. doi:
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      Simon Salzmann, Christian Burri, Sami Al-Nawaiseh, Philip Wakili, Christoph Meier; Optical Coherence Tomography Navigated Laser Retinopexy for Retinal Breaks. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3793 – F0214.

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

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Abstract

Purpose : The prevalent cause of retinal detachment is a full-thickness retinal break, which allows fluid to enter the subretinal space from the vitreous cavity. To prevent progression of the detachment, laser photocoagulation (LPC) lesions are placed around the break in clinical practice to seal the tissue. The treatment is usually performed under indirect ophthalmoscopy. Therefore, the subretinal damage can be difficult to delineate and an experienced operator is required for a successful outcome. In this work, optical coherence tomography (OCT) is used for optimal treatment planning, and LPC is subsequently applied in a navigated and user-friendly procedure.

Methods : The novel method was integrated in a modified OCT diagnostic system (SPECTRALIS OCT, Heidelberg Engineering, Heidelberg, Germany) with integrated treatment laser (Merilas 532 shortpulse, Meridian, Thun, Switzerland). To reliably seal the break, LPC lesions must be applied in regions of still attached retina. Therefore, OCT B-scans were used to manually mark the boundary of the surrounding detachment, which allowed to compute an optimally placed elliptical treatment area. To evaluate the method, artificially provoked retinal breaks were treated accordingly in 10 ex-vivo porcine eyes and the outcome was assessed by fundus photography and OCT imaging.

Results : Ex-vivo experiments showed that OCT-based laser treatment is feasible and the visibility of the subretinal space allows precise treatment planning. A total of 99 to 227 automatically applied lesions per eye at 200 ms and 200 mW were evident as coagulation in color fundus photography. Furthermore, OCT cross-sectional scans showed the required ruptures of the retina at the LPC application sites (Figure 1).

Conclusions : The results indicate the potential of OCT navigated laser retinopexy to achieve high treatment accuracy, efficiency, and safety. Future studies should address treatment of peripheral breaks and the integration of the existing tracking and follow-up functionalities to further enhance and facilitate the treatment.

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

 

Retinal break treatment outcome in an ex-vivo porcine eye. Fundus photographs before (A) and after (B) treatment, infrared scanning laser ophthalmoscope images before (C) and after (E) treatment with the corresponding OCT B-scans (D)(F). The effect of LPC treatment is visible in (B)(E) as spots of whitened tissue and in (F) as ruptures in the retina at the treatment sites (marked in red).

Retinal break treatment outcome in an ex-vivo porcine eye. Fundus photographs before (A) and after (B) treatment, infrared scanning laser ophthalmoscope images before (C) and after (E) treatment with the corresponding OCT B-scans (D)(F). The effect of LPC treatment is visible in (B)(E) as spots of whitened tissue and in (F) as ruptures in the retina at the treatment sites (marked in red).

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