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Automated stereo vision instrument tracking for intraoperative OCT guided anterior segment ophthalmic surgical maneuvers.

ABSTRACT: Microscope-integrated intraoperative OCT (iOCT) enables imaging of tissue cross-sections concurrent with ophthalmic surgical maneuvers. However, limited acquisition rates and complex three-dimensional visualization methods preclude real-time surgical guidance using iOCT. We present an automated stereo vision surgical instrument tracking system integrated with a prototype iOCT system. We demonstrate, for the first time, automatically tracked video-rate cross-sectional iOCT imaging of instrument-tissue interactions during ophthalmic surgical maneuvers. The iOCT scan-field is automatically centered on the surgical instrument tip, ensuring continuous visualization of instrument positions relative to the underlying tissue over a 2500 mm(2) field with sub-millimeter positional resolution and <1° angular resolution. Automated instrument tracking has the added advantage of providing feedback on surgical dynamics during precision tissue manipulations because it makes it possible to use only two cross-sectional iOCT images, aligned parallel and perpendicular to the surgical instrument, which also reduces both system complexity and data throughput requirements. Our current implementation is suitable for anterior segment surgery. Further system modifications are proposed for applications in posterior segment surgery. Finally, the instrument tracking system described is modular and system agnostic, making it compatible with different commercial and research OCT and surgical microscopy systems and surgical instrumentations. These advances address critical barriers to the development of iOCT-guided surgical maneuvers and may also be translatable to applications in microsurgery outside of ophthalmology.

SUBMITTER: El-Haddad MT

PROVIDER: S-EPMC4541528 | biostudies-other | 2015 Aug

REPOSITORIES: biostudies-other

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Project description:PurposeTo assess the effects of age and refractive status on anterior segment anatomical structures, including the ciliary body, using a new swept-source anterior segment optical coherence tomography (AS-OCT) device.MethodsThis prospective observational study included 63 healthy volunteers (mean age: 44.2 years). Images of the anterior segment were obtained using a new swept-source AS-OCT (ANTERION, Heidelberg Engineering GmbH, Heidelberg, Germany) with tracking and image averaging from the right eye of all participants. Repeatability as well as inter- and intra-observer reliability of biometric measurements were evaluated. The impact of image tracking and averaging on ciliary muscle measurements was tested. Univariate and multivariable statistical models were developed to evaluate the relationship of age and refractive status on anterior segment biometric measurements.ResultsFor all test-retest repeatability and inter- and intra-observer reproducibility of swept-source AS-OCT measurements, high intraclass correlation (ICC) was noted (0.88-1.00). The nasal maximum ciliary muscle thickness (CMTMAX) and distance between scleral spur to the thickest point of the ciliary muscle (SSMAX) were larger than those on the temporal side (p<0.001 and p = 0.006, respectively). Nasal and temporal CMTMAX (p = 0.004 and p<0.001, respectively) and lens thickness (p<0.01) increased with age. Nasal and temporal SSMAX decreased with older age and increasing hyperopia (p = 0.01 and p<0.001, respectively). Image averaging resulted in improved ciliary muscle measurements (p = 0.008 to 0.02). Lens vault increased with older age and increased hyperopia (p<0.01). OCT measurements of the angle decreased with older age and increased hyperopia (p<0.001 to 0.03). Aqueous depth decreased with older age and increased hyperopia (p<0.01). Pupil diameter decreased with older age (p<0.01).ConclusionsRepeatability and reproducibility of biometric measurements using the ANTERION AS-OCT were excellent. Image averaging improved the accuracy of ciliary muscle measurements. The device produced measurements of biometric parameters that described superficial and deep structures including the ciliary body and full lens thickness from a single image.

Project description:PURPOSE:To report the 3-year assessment of feasibility and usefulness of microscope-integrated intraoperative OCT (iOCT) during ophthalmic surgery. DESIGN:Prospective, consecutive case series. PARTICIPANTS:Adult participants undergoing incisional ophthalmic surgery with iOCT imaging who consented to be enrolled in the Determination of Feasibility of Intraoperative Spectral-Domain Microscope Combined/Integrated OCT Visualization during En Face Retinal and Ophthalmic Surgery (DISCOVER) study. METHODS:The DISCOVER study is a single-site, multisurgeon, institutional review board-approved investigational device prospective study. Participants included patients undergoing anterior or posterior segment surgery who underwent iOCT imaging with 1 of 3 prototype microscope-integrated iOCT systems (i.e., Zeiss Rescan 700, Leica EnFocus, or Cole Eye iOCT systems). Clinical characteristics were documented, iOCT was directed by the operating surgeon at predetermined surgical time points, and each surgeon completed a questionnaire after surgery to evaluate the usefulness of iOCT during surgery. MAIN OUTCOME MEASURES:Feasibility of iOCT based ability to obtain an OCT image during surgery and usefulness of iOCT based on surgeon reporting during surgery. RESULTS:Eight hundred thirty-seven eyes (244 anterior segment cases and 593 posterior segment cases) were enrolled in the DISCOVER study. Intraoperative OCT demonstrated feasibility with successful image acquisition in 820 eyes (98.0%; 95% confidence interval [CI], 96.8%-98.8%). In 106 anterior segment cases (43.4%; 95% CI, 37.1%-49.9%), the surgeons indicated that the iOCT information impacted their surgical decision making and altered the procedure. In posterior segment procedures, surgeons reported that iOCT enabled altered surgical decision making during the procedure in 173 cases (29.2%; 95% CI, 25.5%-33.0%). CONCLUSIONS:The DISCOVER iOCT study demonstrated both generalized feasibility and usefulness based on the surgeon-reported impact on surgical decision making. This large-scale study confirmed similar findings from other studies on the potential value and impact of iOCT on ophthalmic surgery.

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Automated stereo vision instrument tracking for intraoperative OCT guided anterior segment ophthalmic surgical maneuvers.

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