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Comment
. 2017 Aug;95(5):e431-e432.
doi: 10.1111/aos.13123. Epub 2016 Jun 20.

Intra-operative microscope-integrated swept-source optical coherence tomography guided placement of Argus II retinal prosthesis

Dilraj S Grewal  1 , Oscar M Carrasco-Zevallos  2 , Randall Gunther  2 , Joseph A Izatt  2 , Cynthia A Toth  1   2 , Paul Hahn  1
Affiliations
Comment

Intra-operative microscope-integrated swept-source optical coherence tomography guided placement of Argus II retinal prosthesis

Dilraj S Grewal et al. Acta Ophthalmol. 2017 Aug.
No abstract available

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Conflict of interest statement

Conflict of interest:

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Paul Hahn reports a consulting agreement with Second Sight Medical Products, Inc. Sylmar, CA. No other disclosures were reported. The authors have full control of all primary data.

Figures

Figure 1
Figure 1
Intraoperative microscope-integrated high-speed (100,000 A-scans/second) swept-source optical coherence tomography (OCT) imaging: Sequential OCT B-scans (left column) and maximum intensity projection (MIP) en face MIOCT images (right column) during placement of the metallic retinal tack to secure the array. Prior to retinal tacking, the array (posterior array margins visualized as hyperreflective surfaces indicated by yellow arrows, the array handle visualized as a hyperreflective oval indicated by the red star, and the cable by the white star) is tilted on the retinal surface (a). As the 19-gauge tacking forceps (shadow cast by the forceps indicated with the white triangle) initially lowers the array towards the retina, the array is visualized still not fully apposed to the retinal surface (b). With progressive pressure with the tacking forceps, array apposition is visualized (c). Further pressure during tack placement results in posterior displacement of the globe, causing part of the image to temporarily move out of the OCT imaging range, resulting in a mirror image artifact on the B-scan and a circumferential darkening of the retinal surface surrounding the array on the en face MIP image (d, white arrows). Following tack placement and release of the tacking forceps, the OCT images returns to within imaging range and B-scan confirms close approximation of the array with the inner retinal surface and centration over the foveal pit as shown by the yellow star (e). Post-retinal tack placement intraoperative MIOCT B-scans show appropriate position of the entire array as represented in the three shown locations (e-g). Note the close approximation of the array (yellow arrows) with the inner retinal surface (e-g) and centration over the foveal pit (e, yellow star). Shadowing is noted directly below the metal electrodes (e-g, red arrows) and under the metal tack (g, blue star), and penetration of the tack through the retinal layers therefore cannot be visualized with OCT. In contrast, the transparent polymer between these electrodes allows visibility of the underlying retina. Figure h shows a distance topography map demonstrating the electrode-inner retina distances in microns. The map was created using the Duke OCT Retinal Analysis Program (DOCTRAP) by manually segmenting the lower boundary of the array and inner boundary of the retina on each individual B scan. The area in red represents increased array-retina distance at the foveal pit. Postoperative spectral domain OCT (Spectralis, Heidelberg, Germany) obtained in clinic 4 weeks post-implantation confirms continued optimal array position overlying the foveal pit (yellow star) without a visible shift in position between the intraoperative supine position (a-g) and postoperative sitting position in clinic (i).
See this image and copyright information in PMC

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References

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