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Review
. 2016 May;27(3):201-9.
doi: 10.1097/ICU.0000000000000258.

Clinical utility of intraoperative optical coherence tomography

Mehnaz Khan  1 , Justis P Ehlers
Affiliations
Review

Clinical utility of intraoperative optical coherence tomography

Mehnaz Khan et al. Curr Opin Ophthalmol. 2016 May.

Abstract

Purpose of review: To explore the clinical utility of intraoperative optical coherence tomography (iOCT) for the management of vitreoretinal conditions.

Recent findings: The role of iOCT in guiding surgical decision-making and surgical manipulations during vitreoretinal procedures has been evaluated by multiple studies. This imaging modality is emerging as a valuable asset during procedures for vitreoretinal interface disorders, retinal detachments, submacular surgeries and therapeutics, and in pediatric conditions such as retinopathy of prematurity. iOCT allows the surgeon to assess completion of surgical goals and to directly monitor the architectural impact of instrument-tissue interactions that may correlate with eventual prognosis. The technology has gone through numerous iterations with the eventual goal being the development of a user-friendly, efficient, and integrated system that provides surgeons with 'real-time' feedback during ophthalmic surgeries to allow for a comprehensive image-assisted vitreoretinal surgery platform.

Summary: The role of iOCT in ophthalmic surgery has been evolving with the help of ongoing research to define its utility in the operating room and to develop integrative technologies. Advancements in OCT-friendly surgical instrumentation and in integrative capabilities of this technology may help achieve more widespread adoption of this technology in the vitreoretinal surgical theater. Although the evidence appears clear that this technology impacts surgical decision-making, additional research is needed. However, further research is needed to determine the influence of this technology on overall patient outcomes.

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Figures

Figure 1
Figure 1. Intraoperative OCT During Epiretinal Membrane Surgery
(A) Pre-peel intraoperative OCT demonstrating prominent epiretinal membrane (arrowhead) with some increased shadowing following administration of indocyanine green for staining. (B) Post-peel intraoperative OCT confirming complete removal of epiretinal membrane.
Figure 2
Figure 2. Intraoperative OCT and Macular Hole Surgery
(A) Following internal limiting membrane peeling, intraoperative OCT confirms complete membrane removal around the macular hole.
Figure 3
Figure 3. Proliferative Diabetic Retinopathy and Intraoperative OCT
(A) Complex combined tractional rhegmatogenous retinal detachment involving the macula. (B) Utilizing intraoperative OCT, a subclinical retinal hole (arrowhead) is identified with associated tractional membranes. Identification of this retinal break facilitates surgical repair and removal of membranes.
Figure 4
Figure 4. Subretinal Perfluorocarbon Liquid, Proliferative Vitreoretinopathy and Intraoperative OCT
(A) Subfoveal perfluorocarbon liquid (arrowhead) is identified utilizing intraoperative OCT. (B) Associated proliferative vitreoretinopathy and retinal detachment are visualized with intraoperative OCT. Preretinal membrane (arrow) identification is facilitated with intraoperative OCT and guides surgical maneuvers for membrane removal.
Figure 5
Figure 5. Retinal Detachment Repair and Intraoperative OCT
(A) Macula-involving rhegmatogenous retinal detachment visualized with intraoperative OCT with associated subfoveal fluid (arrowhead). (B) Following placement of perfluorocarbon liquid, significant improvement in subretinal fluid is visualized, but persistent submacular fluid remains (arrowhead).
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