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Review
. 2014 May;25(3):221-7.
doi: 10.1097/ICU.0000000000000044.

The value of intraoperative optical coherence tomography imaging in vitreoretinal surgery

Justis P Ehlers  1 , Yuankai K Tao, Sunil K Srivastava
Affiliations
Review

The value of intraoperative optical coherence tomography imaging in vitreoretinal surgery

Justis P Ehlers et al. Curr Opin Ophthalmol. 2014 May.

Abstract

Purpose of review: To evaluate the role of intraoperative optical coherence tomography (iOCT) in vitreoretinal surgery, assess the current state-of-the art, and to examine possible future directions in the field.

Recent findings: Numerous vitreoretinal surgical conditions and procedures have been described utilizing iOCT. These conditions include macular holes, epiretinal membranes, retinal detachments, and retinopathy of prematurity. Significant alterations appear to occur during surgical manipulations in many of these conditions that can be identified with iOCT. The most common current systems used are portable OCT probes that are either mounted to a microscope or used in a handheld fashion. Prototypes are also being utilized that are integrated into the microscope to allow for true 'real-time' imaging of instrument-tissue interactions. Current generation surgical instrument materials (e.g., metal) limit optimal visualization with integrated OCT systems because of shadowing and light scattering properties.

Summary: The role of iOCT in vitreoretinal surgery continues to be defined by active research and enhancements to integrative technologies. Further research is needed to better define the specific applications of iOCT that impact patient outcomes and surgical decision-making. Future advancements in integrative systems, OCT-friendly instrumentation, and software algorithms will further expand the horizon of iOCT in the vitreoretinal surgical theater. As OCT transformed the clinical management of the vitreoretinal conditions, iOCT has the potential to be a paradigm-shifting technology in the operating room.

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Conflict of interest statement

Conflicts of Interest

Other Financial Disclosures:

JPE: Bioptigen (Royalties, Intellectual property rights); Thrombogenics (Consultant/Speaker); Regeneron (Speaker)

YKT: None

SKS: Bioptigen (Royalties/IP); Alimera (Consultant), Bausch and Lomb (Consultant), Regeneron (Consultant), Allergan (Research grants), Novartis (Research grants), Clearside (Research grants)

Figures

Figure 1
Figure 1
Epiretinal membrane and iOCT. (A) Pre-peel iOCT scan showing prominent epiretinal membrane (red arrow). (B) Post-peel scan confirms removal of the epiretinal membrane (yellow arrow) and reveals areas of increased subretinal hyporeflectivity in the areas of peeling (orange arrows). iOCT: intraoperative optical coherence tomography.
Figure 2
Figure 2
Systems utilized for intraoperative scanning. (A) Microscope-mounted portable OCT probe (red circle). (B) Second-generation microscope integrated OCT prototype (yellow area) allowing for simultaneous surgeon viewing and OCT scanning.
Figure 3
Figure 3
Macular hole segmentation algorithm showing three dimensional reconstruction of the hole configuration.
Figure 4
Figure 4
OCT-friendly instrumentation. (A) Color photograph of a prototype surgical pick tip composed of novel material for OCT-scanning. (B) OCT B-scan of prototype surgical pick with minimal shadowing of underlying material and excellent visualization of the instrument tip.
See this image and copyright information in PMC

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