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Proceedings Paper

4D microscope-integrated OCT improves accuracy of ophthalmic surgical maneuvers
Author(s): Oscar Carrasco-Zevallos; Brenton Keller; Christian Viehland; Liangbo Shen; Bozho Todorich; Christine Shieh; Anthony Kuo; Cynthia Toth; Joseph A. Izatt
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Paper Abstract

Ophthalmic surgeons manipulate micron-scale tissues using stereopsis through an operating microscope and instrument shadowing for depth perception. While ophthalmic microsurgery has benefitted from rapid advances in instrumentation and techniques, the basic principles of the stereo operating microscope have not changed since the 1930’s. Optical Coherence Tomography (OCT) has revolutionized ophthalmic imaging and is now the gold standard for preoperative and postoperative evaluation of most retinal and many corneal procedures. We and others have developed initial microscope-integrated OCT (MIOCT) systems for concurrent OCT and operating microscope imaging, but these are limited to 2D real-time imaging and require offline post-processing for 3D rendering and visualization. Our previously presented 4D MIOCT system can record and display the 3D surgical field stereoscopically through the microscope oculars using a dual-channel heads-up display (HUD) at up to 10 micron-scale volumes per second. In this work, we show that 4D MIOCT guidance improves the accuracy of depth-based microsurgical maneuvers (with statistical significance) in mock surgery trials in a wet lab environment. Additionally, 4D MIOCT was successfully performed in 38/45 (84%) posterior and 14/14 (100%) anterior eye human surgeries, and revealed previously unrecognized lesions that were invisible through the operating microscope. These lesions, such as residual and potentially damaging retinal deformation during pathologic membrane peeling, were visualized in real-time by the surgeon. Our integrated system provides an enhanced 4D surgical visualization platform that can improve current ophthalmic surgical practice and may help develop and refine future microsurgical techniques.

Paper Details

Date Published: 4 March 2016
PDF: 7 pages
Proc. SPIE 9693, Ophthalmic Technologies XXVI, 969306 (4 March 2016); doi: 10.1117/12.2212857
Show Author Affiliations
Oscar Carrasco-Zevallos, Duke Univ. (United States)
Brenton Keller, Duke Univ. (United States)
Christian Viehland, Duke Univ. (United States)
Liangbo Shen, Duke Univ. (United States)
Bozho Todorich, Duke Univ. Medical Ctr. (United States)
Christine Shieh, Duke Univ. Medical Ctr. (United States)
Anthony Kuo, Duke Univ. Medical Ctr. (United States)
Cynthia Toth, Duke Univ. Medical Ctr. (United States)
Duke Univ. (United States)
Joseph A. Izatt, Duke Univ. (United States)
Duke Univ. Medical Ctr. (United States)

Published in SPIE Proceedings Vol. 9693:
Ophthalmic Technologies XXVI
Fabrice Manns; Per G. Söderberg; Arthur Ho, Editor(s)

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