Intraoperative Optical Coherence Tomography-Assisted Chorioretinal Biopsy in the DISCOVER Study.
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ABSTRACT:
SUBMITTER: Browne AW
PROVIDER: S-EPMC5648642 | biostudies-literature | 2017 Nov
REPOSITORIES: biostudies-literature
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Intraoperative Optical Coherence Tomography-Assisted Chorioretinal Biopsy in the DISCOVER Study.
Browne Andrew W AW Ehlers Justis P JP Sharma Sumit S Srivastava Sunil K SK
Retina (Philadelphia, Pa.) 20171101 11
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Project description:PurposeTo investigate the utility of intraoperative optical coherence tomography (OCT) for Descemet membrane endothelial keratoplasty (DMEK) surgery.DesignProspective consecutive interventional case series.MethodsDISCOVER (NCT02423213) is a prospective consecutive interventional case series examining the feasibility and utility of microscope-integrated intraoperative OCT in ophthalmic surgery. This report focuses on those eyes in the DISCOVER study undergoing DMEK surgery. The 8 cases were the first DMEK cases performed by the primary surgeon (J.M.G.) with microscope-integrated intraoperative OCT feedback. Qualitative OCT analysis was performed at multiple surgeon-defined time points, including host and donor tissue preparation, graft orientation, graft apposition, and tissue interface fluid dynamics.ResultsCorrect graft orientation was confirmed by intraoperative OCT prior to unscrolling in 100% of cases. Seven of 8 grafts were fully attached at the conclusion of surgery and on postoperative day 1. One graft had a linear paracentral fixed area of interface separation corresponding to posterior stromal irregularities that was visible during surgery and unchanged on postoperative day 1. Two eyes developed significant peripheral graft dehiscence visible by the first postoperative week. Both grafts were successfully reattached with repeat gas injection. All eyes demonstrated improvement in best-corrected visual acuity and there was a 100% graft survival rate at last follow-up (minimum 4 months). Surgeon feedback indicated that intraoperative OCT provided valuable information in all 8 cases.ConclusionsReal-time intraoperative OCT can provide useful information that may directly impact surgical decision making during DMEK surgery. Intraoperative OCT may facilitate the transition for novice DMEK surgeons by increasing surgeon confidence and reducing the risk of iatrogenic graft failure.
| S-EPMC4544647 | biostudies-literature
Project description:PurposeWe report a case of retrocorneal fibrous membrane (RCFM) formation following penetrating keratoplasty (PK) and intraoperative optical coherence tomography (OCT)-guided excision of this membrane.ObservationsA 68-year-old woman with primary open angle glaucoma and corneal decompensation of the right eye secondary to tube shunt presented for 3-month follow-up of PK. On examination of the right eye, the patient was noted to have a glassy pupillary membrane with traction on the iris. Anterior segment OCT confirmed a membrane connecting the iris to host cornea. The patient underwent biopsy and excision of the membrane assisted by intraoperative OCT. Pathological examination was consistent with Descemet's membrane proliferation. We suspect that this membrane represents retained host's Descemet's membrane following corneal transplantation.ConclusionsThis case highlights the existence of RCFM formation in the context of retained host cornea following PK and the role of intraoperative OCT in management.
| S-EPMC6038824 | biostudies-literature
Project description:Significant integrative advances are needed for intraoperative optical coherence tomography (iOCT) to achieve widespread use across ophthalmic surgery. A surgeon feedback system that provides microscope integration, heads-up display and foot pedal control of the OCT scan location represents a major interval advance in ophthalmic surgery. In this report, we describe the preliminary findings of the Determination of feasibility of Intraoperative Spectral domain microscope Combined/integrated OCT Visualisation during En face Retinal and ophthalmic surgery (DISCOVER) study, a multisurgeon investigational device study examining the role of microscope integrated iOCT systems with surgeon heads-up display feedback (eg, Carl Zeiss Meditec RESCAN 700, Cole Eye Institute iOCT prototype). During surgical manoeuvres in anterior segment and posterior segment surgery, this technology provides rapid visualisation of the area of interest and provides the surgeon with information regarding instrument-tissue interactions. This system represents a major advance in iterative technology for iOCT and may provide the first widely available platform for surgeons to seamlessly assimilate this technology into the operating room theatre.
| S-EPMC4169737 | biostudies-literature
Project description:Aicardi syndrome is a rare congenital disorder with a classic triad of infantile spasms, chorioretinal lacunae, and agenesis of the corpus callosum. We report the use of fluorescein angiography and spectral domain optical coherence tomography to examine the posterior segment structures in an 8-month-old girl with Aicardi syndrome. Most of the observed features correlated with previously published histopathological findings, but inner nuclear layer cysts have not been previously described. To our knowledge, this is the first study of the tomographic and angiographic chorioretinal features in vivo.
| S-EPMC3142350 | biostudies-literature
Project description:ObjectiveTo report intraoperative optical coherence tomography (iOCT)-assisted 27-gauge microincision vitrectomy surgery (MIVS) in eyes with vitreoretinal disease.MethodsA retrospective, interventional case series performed at a single center, including 6 eyes with retinal disease that underwent iOCT-assisted 27-gauge MIVS.ResultsThe advantages of iOCT were most notable when it was used to evaluate, in real time, different macular areas: the pre-macula, in vitreomacular traction or epiretinal membrane; the intra-macula, in macular edema or macular hole; and the sub-macula, in macular detachment. Real-time imaging and the minimization of shadows cast on the underlying tissues by the 27-gauge instrumentation made it possible to quickly select the best procedure at each critical juncture of the surgery. No patients experienced any complications.ConclusionReal-time iOCT imaging during 27-gauge MIVS provided excellent intraoperative visualization of retinal tissues without causing significant obstructions to the surgeon. The positive feedback from the system allowed the surgeon to better judge the necessity of additional surgical procedures.
| S-EPMC4519593 | biostudies-literature
Project description:PurposeTo evaluate the feasibility of integrating intraoperative optical coherence tomography (OCT) with a digital visualization platform for vitreoretinal surgery.MethodsThe DISCOVER study is a prospective study examining microscope-integrated intraoperative OCT across multiple prototypes and platforms. For this assessment, a microscope-integrated OCT platform was combined with a three-dimensional (3D) surgical visualization system to allow for digital display of the OCT data stream on the large immersive display. Intraoperative OCT scans were obtained at various surgical milestones that were directly overlaid to the surgical view in a 55-inch passive 3D 4K high-definition display. Surgeon feedback was obtained related to system performance and integration into the surgical procedures through a prespecified surgeon questionnaire.ResultsSeven eyes of seven subjects were identified. Clinical diagnosis included epiretinal membrane (n = 3), macular hole (2), symptomatic vitreous opacity (1), and proliferative vitreoretinopathy (1). Optical coherence tomography images were successfully obtained and displayed on the 4K screen in all cases. Intraoperative OCT images facilitated identification of subtle retinal alterations. Surgeons reported that the 4K screen seemed to provide improved visualization of the OCT data stream compared with the semitransparent ocular view. Surgeons were able to examine the OCT data on the 4K screen without reverting to the external display system of the microscope. The system provided a uniform surgical visualization experience for both the surgeon and the assistant. In addition, the digital platform allowed all surgical personnel to simultaneously view both the OCT and the surgical field. All eyes underwent uneventful vitrectomy without reverting to the conventional microscope. No intraoperative adverse events occurred.ConclusionIntegration of OCT into the digital visualization system may enable unique opportunities for surgeon feedback of intraoperative diagnostics. The overlay of the OCT data onto the 4K monitor seemed to provide excellent visualization of OCT details. Further research is needed to compare the conventional microscope-based approach to the digital 3D screen approach in regards to intraoperative OCT.
| S-EPMC6005714 | biostudies-literature
Project description:PurposeTo evaluate the clinical feasibility of peripheral chorioretinal imaging through a front prism on swept-source optical coherence tomography angiography (SS-OCTA).MethodsWe prospectively obtained en face OCTA images using SS-OCTA in 10 eyes of 10 healthy volunteers. For the peripheral chorioretinal imaging, the scanning laser passed and refracted through a 45°-90°-45° right-angle prism. We evaluated the qualitative and quantitative characteristics of chorioretinal vessels in the periphery.ResultsUsing peripheral chorioretinal imaging through a prism, the retinal vasculature was delineated to the equator on the OCTA images, and varices of the vortex vein ampullae were observed on choroidal OCT images. The 3 × 3-mm images revealed three-dimensional morphologies unique to the peripheral vasculature, such as the gap between retinal arterioles and venules in the superficial capillary plexus (SCP) and elliptical and greater lobules in the choriocapillaris layer. Compared with OCTA images obtained without the prism, those obtained through the prism demonstrated an approximately 1.24-fold increase in the lengths in the base apex direction, whereas the lengths in the perpendicular direction showed concordance. The peripheral vessel density (VD) in the inferior quadrant was lower than those in the other quadrants on the SCP and deep capillary plexus, whereas on the SCP images of the macula the lowest VD was observed in the temporal subfield.ConclusionsPeripheral chorioretinal imaging allowed us to generate ultra-widefield panoramic OCTA images and demonstrated morphologic characteristics unique to peripheral chorioretinal vessels.Translational relevanceOCTA imaging through a front prism can be a technique for acquiring chorioretinal vasculature images in the periphery.
| S-EPMC8727309 | biostudies-literature
Project description:PurposeTo correlate intraoperative interface fluid dynamics during Descemet stripping automated endothelial keratoplasty (DSAEK) using intraoperative optical coherence tomography (iOCT) in the Prospective Intraoperative and Perioperative Ophthalmic Imaging with Optical Coherence Tomography (PIONEER) study with postoperative outcomes.DesignProspective consecutive, interventional, comparative case series.ParticipantsOne hundred seventy-eight eyes of 173 patients undergoing DSAEK from the Cole Eye Institute, Cleveland, Ohio.MethodsEyes that underwent DSAEK between October 2011 and March 2014 from the PIONEER intraoperative and perioperative OCT study were included. An automated interface fluid segmentation algorithm evaluated intraoperative dynamics of interface fluid before and after surgical manipulations. iOCT images were also captured at multiple intraoperative time points for 2 different DSAEK techniques, 1 that used an active air infusion system and 1 that did not.Main outcome measuresInterface fluid metrics, graft nonadherence.ResultsiOCT measurements of interface fluid after final surgical manipulations and immediately before leaving the operating room identified that total fluid volume (P = .002), largest fluid volume pocket (P = .002), max fluid area (P = .006), mean fluid thickness (P = .03), and max fluid thickness (P = .01) significantly correlated with graft nonadherence rates within the first postoperative week. After placement and optimization of intraoperative lenticle adherence, iOCT revealed a significant difference between the area, volume, and thickness of maximum fluid pockets between the 2 surgical techniques, but both techniques resulted in significant reduction of interface fluid during the procedure.ConclusionsLarger residual interface fluid volume, area, and thickness at the end of surgery detected with iOCT are associated with early graft nonadherence and can be quantified with an automated algorithm. iOCT imaging can successfully capture technique-dependent differences in fluid dynamics during DSAEK.
| S-EPMC5136509 | biostudies-literature
Project description:Despite the rapid development of optical imaging methods, high-resolution in vivo imaging with penetration into deeper tissue layers is still a major challenge. Optical coherence tomography (OCT) has been used successfully for non-invasive human retinal volumetric imaging in vivo, advancing the detection, diagnosis, and monitoring of various retinal diseases. However, there are important limitations of volumetric OCT imaging, especially coherent noise and the limited axial range over which high resolution images can be acquired. The limited range prevents simultaneous measurement of the retina and choroid with adequate lateral resolution. In this article, we address these limitations with a technique that we term spatio-temporal optical coherence tomography (STOC-T), which uses light with controlled spatial and temporal coherence and advanced signal processing methods. STOC-T enabled the acquisition of high-contrast and high-resolution coronal projection images of the retina and choroid at arbitrary depths.
| S-EPMC9676634 | biostudies-literature
Project description:In this systematic review, we provide an overview of the current state of intraoperative optical coherence tomography (iOCT). As iOCT technology is increasingly utilized, its current clinical applications and potential uses warrant attention. Here, we categorize the findings of various studies by their respective fields, including the use of iOCT in vitreoretinal surgery, corneal surgery, glaucoma surgery, cataract surgery, and pediatric ophthalmology. The trend observed in recent decades towards performing minimally invasive ophthalmic surgery has caused practitioners to recognize the limitations of using a conventional surgical microscope for intraoperative visualization. Thus, the superior visualization provided by iOCT can improve the safety of these surgical techniques and promote the development of new minimally invasive ophthalmic surgeries. Landmark prospective studies found that iOCT can significantly affect surgical decision making and can cause a subsequent change in surgical strategy, and the use of iOCT has potential to improve surgical outcome. Despite these advantages, however, iOCT is still a relatively new technique, and beginning users of iOCT can encounter limitations that can preclude their reaching the full potential of iOCT and in this respect several improvements are needed.
| S-EPMC8807841 | biostudies-literature