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Intraoperative optical coherence tomography using the RESCAN 700: preliminary results from the DISCOVER study.

ABSTRACT: 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.

SUBMITTER: Ehlers JP

PROVIDER: S-EPMC4169737 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Intraoperative optical coherence tomography using the RESCAN 700: preliminary results from the DISCOVER study.

Ehlers Justis P JP Kaiser Peter K PK Srivastava Sunil K SK

The British journal of ophthalmology 20140429 10

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 Vi ...[more]

PMID: 24782469

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Project description:Optical coherence tomography (OCT) has transformed the clinical management of a myriad of ophthalmic conditions. Applying OCT to ophthalmic surgery may have implications for surgical decision making and patient outcomes.To assess the feasibility and effect on surgical decision making of a microscope-integrated intraoperative OCT (iOCT) system.Report highlighting the 1-year results (March 2014-February 2015) of the RESCAN 700 portion of the DISCOVER (Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery) study, a single-site, multisurgeon, prospective consecutive case series regarding this investigational device. Participants included patients undergoing ophthalmic surgery. Data on clinical characteristics were collected, and iOCT was performed during surgical milestones, as directed by the operating surgeon. A surgeon questionnaire was issued to each surgeon and was completed after each case to evaluate the role of iOCT during surgery and its particular role in select surgical procedures.Percentage of cases with successful acquisition of iOCT (ie, feasibility). Percentage of cases in which iOCT altered surgical decision making (ie, utility).During year 1 of the DISCOVER study, a total of 227 eyes (91 anterior segment cases and 136 posterior segment cases) underwent imaging with the RESCAN 700 system. Successful imaging (eg, the ability to acquire an OCT image of the tissue of interest) was obtained for 224 of 227 eyes (99% [95% CI, 98%-100%]). During lamellar keratoplasty, the iOCT data provided information that altered the surgeon's decision making in 38% of the cases (eg, complete graft apposition when the surgeon believed there was interface fluid). In membrane peeling procedures, iOCT information was discordant with the surgeon's impression of membrane peel completeness in 19% of cases (eg, lack of residual membrane or presence of occult membrane), thus affecting additional surgical maneuvers.The DISCOVER study demonstrates the feasibility of real-time iOCT with a microscope-integrated iOCT system for ophthalmic surgery. The information gained from iOCT appears to allow surgeons to assess subtle details in a unique perspective from standard en face visualization, which can affect surgical decision making some of the time, although the effect of these changes in decision making on outcomes remains unknown. A prospective randomized masked trial is needed to confirm these results.

Project description:PURPOSE:To evaluate the feasibility of integrating intraoperative optical coherence tomography (OCT) with a digital visualization platform for vitreoretinal surgery. METHODS:The 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. RESULTS:Seven 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. CONCLUSION:Integration 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.

Dataset Information

Intraoperative optical coherence tomography using the RESCAN 700: preliminary results from the DISCOVER study.

Publications

Intraoperative optical coherence tomography using the RESCAN 700: preliminary results from the DISCOVER study.

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