Feasibility of intrasurgical spectral-domain optical coherence tomography

Abstract

Purpose: To evaluate the feasibility of intrasurgical spectral-domain optical coherence tomography in a pilot study.

Methods: Using a Carl Zeiss Meditec Cirrus HD-OCT system adapted to the optical pathway of a Zeiss OPMI VISU 200 surgical microscope, 512 × 128 macular cube scans were performed during various steps of microsurgical procedures in 25 cases. The acquired volume data were postprocessed and visualized using a ray-traced three-dimensional display system.

Results: The surgical procedures included pars plana vitrectomies for epiretinal membranes (n = 8), macular holes (n = 4), primary rhegmatogenous retinal detachment (n = 1), proliferative diabetic retinopathy (n = 3), silicone oil removal (n = 2), and cataract surgery only (n = 7). It was possible to acquire intraretinal scans with sufficient quality from all patients. Decisions for additional membrane peeling, knowledge about the behavior of the macular hole and the foveal depression during and after membrane removal, information about clinically invisible fluid accumulation under silicone oil or in a clinically diagnosed "macula-on" retinal detachment, and the condition of the fovea immediately after cataract removal could be gained.

Conclusion: Intrasurgical spectral-domain optical coherence tomography evaluation is feasible using the tested system and may positively influence surgical decisions and techniques resulting in an improved patient outcome.