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. 2023 Jun 29;14(7):3798-3811.
doi: 10.1364/BOE.488967. eCollection 2023 Jul 1.

Visualization of surgical maneuvers using intraoperative real-time volumetric optical coherence tomography

Jianwei D Li  1 , Christian Viehland  1 , Al-Hafeez Dhalla  1 , Robert Trout  1 , William Raynor  2 , Anthony N Kuo  1   2 , Cynthia A Toth  1   2 , Lejla M Vajzovic  2 , Joseph A Izatt  1   2
Affiliations

Visualization of surgical maneuvers using intraoperative real-time volumetric optical coherence tomography

Jianwei D Li et al. Biomed Opt Express. .

Abstract

Ophthalmic microsurgery is traditionally performed using stereomicroscopes and requires visualization and manipulation of sub-millimeter tissue structures with limited contrast. Optical coherence tomography (OCT) is a non-invasive imaging modality that can provide high-resolution, depth-resolved cross sections, and has become a valuable tool in clinical practice in ophthalmology. While there has been substantial progress in both research and commercialization efforts to bring OCT imaging into live surgery, its use is still somewhat limited due to factors such as low imaging speed, limited scan configurations, and suboptimal data visualization. In this paper we describe, to the best of our knowledge, the translation of the fastest swept-source intraoperative OCT system with real-time volumetric imaging with stereoscopic data visualization provided via a heads-up display into the operating room. Results from a sampling of human anterior segment and retinal surgeries chosen from 93 human surgeries using the system are shown and the benefits that this mode of intrasurgical OCT imaging provides are discussed.

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Conflict of interest statement

AD: Duke University (P), CZ: Duke University (P), CAT: Duke University Medical Center (P), Alcon Laboratories (R), Theia Imaging (I,C), Emmes (C), LMV: Duke University Medical Center (P), Alcon Inc. (F,C), JAI: Duke University (P)

Figures

Fig. 1.
Fig. 1.
(a) Duke intraoperative OCT system schematic with engine components indicated by dashed orange box and computer in dashed magenta box. FBG (fiber Bragg grating), PD (photodetector), PC (polarization controller), L (lens), RR (retroflector). (b) OCT cart indicating location of the engine and computer with corresponding colored boxes. (c) OCT sample arm mounted on a Leica Proveo 8 surgical microscope with the NGENUITY 3D visualization system camera. (d) NGENUITY 3D visualization system display showing the OCT volume (dashed green box), MIP (dashed yellow box), and selected B-scan (dashed red box) and surgical microscope views (dashed blue box).
Fig. 2.
Fig. 2.
System sensitivity falloff plot of our OCT system. 11.8 µm axial resolution (in air), 94 dB peak sensitivity with 6 dB falloff at 4.15 mm.
Fig. 3.
Fig. 3.
Time sequence showing placement of human amniotic membrane (hAM) patch inside a macular hole (MH). Top row: surgical microscope view with time in seconds in white text. The dashed cyan box indicated FOV of the OCT scan. Bottom row: 3D OCT volumes with the maximum intensity projection (MIP) shown as insets in dashed cyan box. OCT scan parameters: 340 A-scans x 80 B-scans, 5 × 5 mm. A video of this sequence can be found in Visualization 1 and Visualization 2.
Fig. 4.
Fig. 4.
Macular hole (MH) with human amniotic membrane patch (hAM) placed at the bottom of the hole. (a) Surgical microscope view with FOV of OCT indicated with the dashed cyan box. (b) OCT MIP with the (c) B-scan location indicated by the dashed green line. (d) 3D OCT volume. OCT scan parameters: 840 A-scans x 256 B-scans, 5 × 5 mm
Fig. 5.
Fig. 5.
Time sequence showing a subretinal injection (SR). The hemorrhage (H) is clearly visible in both the microscope view and surgical view as the needle (N) injects tPA. Top row: surgical microscope view with time in seconds in white text. The dashed cyan box indicated FOV of the OCT scan. Bottom row: 3D OCT volumes with the maximum intensity projection (MIP) shown as insets in dashed cyan box. OCT scan parameters: 340 A-scans x 80 B-scans, 7 × 7 mm. A video of this sequence can be found in Visualization 3.
Fig. 6.
Fig. 6.
Time sequence showing membrane peeling over a retinal detachment (RD). In the first 3 frames, a flex loop (L) was used. In the last 2 frames, the surgeon switched to ILM forceps (F) and the membrane (M) is clearly visible in the OCT volume. In the last 2 frames a possible schisis is seen in the OCT (dashed blue oval). Top row: surgical microscope view with time in seconds in white text. The dashed cyan box indicated FOV of the OCT scan. Bottom row: 3D OCT volumes with the maximum intensity projection (MIP) shown as insets in dashed cyan box. OCT scan parameters: 340 A-scans x 80 B-scans, 5 × 5 mm. A video of this sequence can be found in Visualization 4 and Visualization 5.
Fig. 7.
Fig. 7.
(a) Volumetric and (b) B-scan view of the submacular hemorrhage. (c) Volumetric and (d) B-scan view of the subretinal injection over the submacular hemorrhage. The blue line in the volumetric views indicated the location of the corresponding B-scan. The segmented region of interest in the B-scan is outlined in red. OCT scan parameters: 750 A-scans x 750 B-scans, 15 × 15 mm.
Fig. 8.
Fig. 8.
(a-c) MIP view including the surgical tool and retina with the corresponding (d-f) B-scans indicated by the green line. The cyan arrow indicates the position of the surgical tool. The magenta line indicates the segmented retina and the arrow indicates the retinal thickness. (g-i) Retinal thickness map over the entire volume, where thinning is indicated in blue and thickening in red. OCT scan parameters: 340 A-scans x 80 B-scans, 3 × 3 mm.
Fig. 9.
Fig. 9.
Time sequence showing a corneal transplant (CT) being sutured (S) into place. Top row: surgical microscope view with time in seconds in white text. The dashed cyan box indicated FOV of the OCT scan. Bottom row: 3D OCT volumes with the maximum intensity projection (MIP) shown as insets in dashed cyan box. OCT scan parameters: 340 A-scans x 80 B-scans, 15 × 15 mm. A video of this sequence can be found in Visualization 6 and Visualization 7.
Fig. 10.
Fig. 10.
(a) OCT MIP with the (b) B-scan location indicated by the dashed green line. (c) 3D OCT volume. OCT scan parameters: 840 A-scans x 256 B-scans, 8 × 8 mm
Fig. 11.
Fig. 11.
Placement of 3-piece intraocular lens (IOL) with optic capture (optic of IOL behind anterior capsule with haptics anterior and in the sulcus) due to a compromised posterior capsule. (a) Surgical microscope view with FOV of OCT indicated with the dashed cyan box. (b) OCT MIP with the (c) B-scan location indicated by the dashed green line. (d) 3D OCT volume. OCT scan parameters: 750 A-scans x 750 B-scans, 15 × 15 mm
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References

    1. Singh M., Saxena A., “Microsurgery: A Useful and Versatile Tool in Surgical Field,” Surgery: Curr. Res. 04(04), 4 (2014).10.4172/2161-1076.1000194 - DOI
    1. Ramachandran S., Ghanem A. M., Myers S. R., “Assessment of microsurgery competency-where are we now?” Microsurgery 33(5), 406–415 (2013).10.1002/micr.22111 - DOI - PubMed
    1. Huang D., Swanson E. A., Lin C. P., Schuman J. S., Stinson W. G., Chang W., Hee M. R., Flotte T., Gregory K., Puliafito C. A., Fujimoto J. G., “Optical Coherence Tomography,” Science 254(5035), 1178–1181 (1991).10.1126/science.1957169 - DOI - PMC - PubMed
    1. Izatt J. A., Hee M. R., Swanson E. A., Lin C. P., Huang D., Schuman J. S., Puliafito C. A., Fujimoto J. G., “Micrometer-Scale Resolution Imaging of the Anterior Eye In Vivo With Optical Coherence Tomography,” Arch. Ophthalmol. 112(12), 1584–1589 (1994).10.1001/archopht.1994.01090240090031 - DOI - PubMed
    1. Puliafito C. A., Hee M. R., Lin C. P., Reichel E., Schuman J. S., Duker J. S., Izatt J. A., Swanson E. A., Fujimoto J. G., “Imaging of Macular Diseases with Optical Coherence Tomography,” Ophthalmology 102(2), 217–229 (1995).10.1016/S0161-6420(95)31032-9 - DOI - PubMed

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