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    [Intraoperative Optical Coherence Tomography - an Overview of Current Clinical Data for the Application in the Anterior and Posterior Segments]. Augustin A J Klinische Monatsblatter fur Augenheilkunde Intraoperative optical coherence tomography (iOCT) represents another milestone in ocular imaging technologies. Now, for the first time, high resolution OCT images are available not only pre- or postoperatively, but also intraoperatively. In recent years, there have been significant advances in iOCT technology - from hand-held probes and mounted systems towards iOCT systems which are fully integrated into the surgical microscope and which provide seamless integration into the workflow. These systems offer high-resolution, intraoperative OCT scans in real-time and provide additional information on microstructures of the retina or the cornea. These findings may even lead to a modification of surgical strategies. Like any other new technology, iOCT technology still has some limitations, such as shadowing from instruments and the lack of eye tracking systems. Therefore, the current state of iOCT technology still requires some skill to track surgical maneuvers in real time. Further research and development will help to solve these limitations in the future. However, even if not required for all surgical procedures, iOCT imaging can already improve safety and control in many surgical procedures on the anterior and posterior segments. This has already been shown in several studies and case series. Particularly in the surgery of vitreomacular traction, peeling of epiretinal membranes (ERM peeling) and macular hole surgery, iOCT offers significant added value. It improves the visualisation of transparent structures and helps to avoid the usage of dyes. In addition the success of the surgical maneuvers can be investigated intraoperatively. In lamellar keratoplasty and glaucoma surgery too, iOCT improves precision and safety. Moreover, iOCT technology may help to achieve further insight into ocular pathologies and a better understanding of the impact of surgical maneuvers on visual rehabilitation. Further prospective studies are however required to evaluate the usefulness of iOCT in various surgical procedures on both, the anterior and posterior segments. 10.1055/s-0042-122710
    [Intraoperative optical coherence tomography for examination of newborns and infants under general anesthesia]. Siebelmann S,Bachmann B,Lappas A,Dietlein T,Steven P,Cursiefen C Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft BACKGROUND:Examination of newborn and children under general anesthesia is essential to prevent amblyopia and blindness; however, the validity was often limited due to a lack of state of the art diagnostic tools in the intraoperative set-up, e. g. optical coherence tomography (OCT). Since OCT devices have been integrated into surgical microscopes, this technique is also available for examination with patients under general anesthesia. OBJECTIVE:To give an overview about the possibilities of intraoperative OCT (iOCT) during examination of newborn and infant children under general anesthesia. MATERIAL AND METHODS:Analysis of recent literature (PubMed) and initial experiences at the Center for Ophthalmology of the University Hospital of Cologne. RESULTS:The use of iOCT enables real-time high-resolution imaging during examinations of children under general anesthesia. All relevant structures of the anterior eye segment (including cornea, lens, chamber angle and iris) can be visualized. Especially when the anterior chamber view is limited due to corneal opacifications, iOCT can deliver important information in addition to that obtained using a surgical microscope. This information is important for the further therapy of the patients. CONCLUSION:Online iOCT is a useful extension of the normal surgical microscope, especially for examination of children under general anesthesia and limited view into the anterior chamber. In our experience it also makes sense to transfer this technique to anomalies of the posterior pole because high-resolution imaging of the macula and optic nerve head is possible. 10.1007/s00347-016-0299-4
    Intrasurgical dynamics of macular hole surgery: an assessment of surgery-induced ultrastructural alterations with intraoperative optical coherence tomography. Ehlers Justis P,Xu David,Kaiser Peter K,Singh Rishi P,Srivastava Sunil K Retina (Philadelphia, Pa.) PURPOSE:To evaluate the intrasurgical retinal architectural and macular hole (MH) geometric alterations that occur during surgical MH repair using intraoperative optical coherence tomography. METHODS:A retrospective, multisurgeon, single-center, consecutive case series of 21 eyes undergoing surgical repair for MH with concurrent intraoperative optical coherence tomography using a custom microscope-mounted optical coherence tomography system was performed. All patients underwent surgical repair with pars plana vitrectomy, membrane peel, and gas tamponade. A novel three-dimensional segmentation algorithm was used for volumetric analysis of intrasurgical changes of MH geometry after surgical repair. Intraoperative optical coherence tomographic characteristics analyzed included MH volume, minimum diameter, base area, and hole height. Outer retinal architecture changes were analyzed both quantitatively and qualitatively. RESULTS:All 21 eyes were successfully imaged with intraoperative optical coherence tomography. Nineteen of 21 eyes had images of sufficient signal strength to allow for quantitative analysis. Significant changes were noted in MH geometry after internal limiting membrane peeling including increased MH volume, increased base area, and decreased top area (all P < 0.03). Additionally, increased subretinal hyporeflectance was noted by expansion of the height between the inner segment/outer segment and retinal pigment epithelium bands (P = 0.008). Peeling methods and surgeon experience did not correlate with the magnitude of architectural alterations. Macular hole algorithm measurements and alterations were associated with visual outcome and MH closure. CONCLUSION:Significant alterations occur in MH geometry and outer retinal structure after internal limiting membrane peeling. These changes are subclinical and unable to be appreciated with en face surgical microscope viewing and require intraoperative optical coherence tomography for visualization. Preliminary analysis of these measurements identified an association with visual outcome and successful MH closure. The functional significance of these changes deserves further study. 10.1097/IAE.0b013e318297daf3
    Intraoperative Optical Coherence Tomography in Idiopathic Macular Epiretinal Membrane Surgery. International journal of general medicine Objective:To evaluate the feasibility and practicability of intraoperative optical coherence tomography (IOCT) in the surgery of idiopathic macular epiretinal membrane (IMM) without internal limiting membrane staining in all patients. Methods:Patients were selected from July 2018 to June 2020, and 32 patients (32 eyes) with IMM were operated with the use of IOCT. All patients underwent standard 23g vitrectomy. The internal limiting membrane was peeled off if there were obvious retinal folds. Intraoperative and postoperative complications, macular microstructural changes, and integrity of the detached membranes were recorded. The preoperative and postoperative best corrected visual acuity were compared. Results:The macular epiretinal membrane was completely removed in 75% (24 eyes) patients without internal limiting membrane staining, and in 15.6% (5 eyes) patients with combined internal limiting membrane stripping. The "starting point" of macular epiretinal membrane stripping was found in 75% (24 eyes), and the time required to find the best starting point ranged from 28s to 140s (mean 66 ± 15s). At 3 months after operation, 96.8% of the patients had stable or improved BCVA (p < 0.05). The central macular thickness of the affected eyes decreased significantly at 1 and 3 months after operation (p < 0.05). Conclusion:IOCT can significantly reduce the use of internal limiting membrane staining in idiopathic macular epiretinal membrane surgery, and it is safe, feasible and practical in idiopathic macular epiretinal membrane surgery without internal limiting membrane staining in all patients. 10.2147/IJGM.S374630
    INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY DURING VITREORETINAL SURGERY FOR DENSE VITREOUS HEMORRHAGE IN THE PIONEER STUDY. Ehlers Justis P,Griffith Joseph F,Srivastava Sunil K Retina (Philadelphia, Pa.) PURPOSE:To evaluate the feasibility and utility of intraoperative optical coherence tomography (OCT) during pars plana vitrectomy surgery for dense vitreous hemorrhage. METHODS:The Prospective Assessment of Intraoperative and Perioperative OCT for Ophthalmic Surgery study examined the utility of intraoperative OCT in ophthalmic surgery. Intraoperative scanning was performed with a microscope-mounted spectral domain OCT system. This report is a case series of those eyes undergoing pars plana vitrectomy for dense central vitreous hemorrhage that precluded preoperative OCT assessment. Intraoperative OCT images were qualitatively evaluated for retinal abnormalities that might impact intraoperative or perioperative management. Clinical variables were collected and assessed. Surgeon assessment of intraoperative OCT utility was also evaluated. RESULTS:Twenty-three eyes were identified and included. The etiology for the vitreous hemorrhage was proliferative diabetic retinopathy (19 eyes, 82.6%), horseshoe retinal tear (1 eye, 4.3%), retinal vein occlusion with neovascularization (1 eye, 4.3%), presumed polypoid choroidal vasculopathy (1 eye, 4.3%), and presumed retinal arterial macroaneurysm (1 eye, 4.3%). Intraoperative OCT revealed epiretinal membrane (14 eyes, 60.9%), macular edema (14 eyes, 60.9%), posterior hyaloid traction (1 eye, 4.3%), and retinal detachment (1 eye, 4.3%). Surgeon feedback suggested that intraoperative OCT impacted surgical decision making in eyes where membrane peeling was performed. CONCLUSION:Intraoperative OCT during pars plana vitrectomy for vitreous hemorrhage may provide physicians with clinically relevant information that may impact surgical management, perioperative management, and patient outcomes. 10.1097/IAE.0000000000000660
    Intraoperative Optical Coherence Tomography-Guided Membrane Peeling for Surgery of Macular Pucker: Advantages and Limitations. Leisser Christoph,Hirnschall Nino,Palkovits Stefan,Doeller Birgit,Kefer Katharina,Findl Oliver Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde PURPOSE:Epiretinal membranes (ERMs) are a disorder leading to progressive vision loss and metamorphopsia. The gold standard in therapy is vitrectomy with membrane peeling. The aim of this study was to assess whether the use of intraoperative optical coherence tomography (iOCT), which allows tomographic visualization of the membrane during peeling, enables peeling without staining. METHODS:This prospective study included 30 eyes of 30 patients with idiopathic ERMs scheduled for surgery. Pars plana vitrectomy with iOCT was performed in all cases, whereas staining of ERMs was only performed if needed. Internal limiting membrane (ILM) peeling was performed in case of wrinkled retinal surface after peeling of ERMs. RESULTS:In 63% (n = 19) eyes the ERM could be peeled successfully without use of staining. Nevertheless, in 89% (n = 17) of patients having had ERM peeling without dye, staining of the ILM was performed afterwards for peeling the ILM. Best corrected visual acuity improved in 80% (n = 24) and remained unchanged in 7% (n = 2) 3 months after surgery. There were no significant differences in postoperative results between patients with and without staining for ERM peeling. CONCLUSIONS:Use of iOCT helps to complete ERM peeling in a majority of cases without use of a chromovitrectomy dye, but as iOCT fails to visualize the ILM, chromovitrectomy still facilitates macular surgery in a majority of cases. 10.1159/000493279
    Alterations of Foveal Architecture during Vitrectomy for Myopic Retinoschisis Identified by Intraoperative Optical Coherence Tomography. Itoh Yuji,Inoue Makoto,Kato Yu,Koto Takashi,Hirakata Akito Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde PURPOSE:To determine the changes in the foveal architecture before and after internal limiting membrane (ILM) peeling with and without fovea-sparing ILM peeling (FSIP) during vitrectomy for high myopic retinoschisis by intraoperative optical coherence tomography (iOCT). METHODS:Qualitative assessments were made of the alterations of the retinal architecture imaged by iOCT following complete ILM peeling (peeled group) or fovea-sparing ILM peeling (FSIP group). A microscope-integrated real-time iOCT device was used to analyze the retinal architectures. The alterations included a worsening of the retinoschisis, development of a foveal detachment, and development of a full thickness macular hole. The changes in the retinal architecture, clinical characteristics, and outcomes were compared between the 2 groups. RESULTS:The medical records of 15 eyes of 15 patients were studied. Complete ILM peeling was performed on 9 of 15 eyes, and 8 of the 9 eyes (89%) showed a worsening of the retinal architectures following the ILM peeling. FSIP was performed on 6 of the 15 eyes, and none of these eyes developed any retinal architectural changes in the iOCT images. The mean postoperative best-corrected visual acuity (BCVA) in eyes that underwent FSIP (20/38) was significantly better than that of preoperative BCVA (20/128; p < 0.05), although the differences in the preoperative BCVA (20/87) and postoperative BCVA (20/55) in the cases that underwent complete ILM peeling were not significant. CONCLUSIONS:The lack of alterations of the foveal architecture and significant improvements in the BCVA after FSIP indicate that FSIP peeling should be considered for eyes with retinoschisis. We recommend that iOCT be used to monitor the retinal architecture during intraocular surgery involving the retina. 10.1159/000500362
    Intraoperative Optical Coherence Tomography in Vitreoretinal Surgery. Ung Cindy,Miller John B Seminars in ophthalmology Intraoperative OCT (OCT) is an emerging modality capable of displaying real-time OCT images to the surgeon during surgery. The use of iOCT during vitreoretinal surgery improves our understanding of the tissue alterations that occur during surgical manipulations, which may impact surgical decision-making. We review the current OCT modalities and clinical applications of OCT. 10.1080/08820538.2019.1620811
    INTRAOPERATIVE SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING AFTER INTERNAL LIMITING MEMBRANE PEELING IN IDIOPATHIC EPIRETINAL MEMBRANE WITH CONNECTING STRANDS. Nam Dong Heun,Desouza Philip J,Hahn Paul,Tai Vincent,Sevilla Monica B,Tran-Viet Du,Cunefare David,Farsiu Sina,Izatt Joseph A,Toth Cynthia A Retina (Philadelphia, Pa.) PURPOSE:To report the intraoperative optical coherence tomography findings in idiopathic epiretinal membrane (ERM) with connecting strands and to describe the postoperative outcomes. METHODS:A retrospective, case series study within a prospective observational intraoperative optical coherence tomography imaging study was performed. Epiretinal membranes with connecting strands were characterized on preoperative spectral domain optical coherence tomography images and assessed against corresponding intraoperative (after internal limiting membrane [ILM] peeling) and postoperative spectral domain optical coherence tomography images. RESULTS:Eleven locations of the connecting strands in 7 eyes were studied. The connecting strands had visible connections from the inner retinal surface to the ERM in all locations, and the reflectivity was moderate in 8 locations and high in 3 locations. After ERM and ILM peeling, disconnected strands were identified in all of the intraoperative optical coherence tomography images. The reflectivity of the remaining intraoperative strands was higher than that of the preoperative lesions and appeared as "finger-like" and branching projections. The remaining disconnected lesions were contiguous with the inner retinal layers. Postoperatively, the intraoperative lesions disappeared completely in all locations, and recurrent formation of ERM was not identified in any eyes. CONCLUSION:In ERM eyes with connecting strands, intraoperative spectral domain optical coherence tomography imaging showed moderately to highly reflective sub-ILM finger-like lesions that persist immediately after membrane and ILM peeling. Postoperatively, the hyperreflective lesions disappeared spontaneously without localized nerve fiber layer loss. The sub-ILM connecting strands may represent glial retinal attachments. 10.1097/IAE.0000000000000534
    Microscope-Integrated Intraoperative Ultrahigh-Speed Swept-Source Optical Coherence Tomography for Widefield Retinal and Anterior Segment Imaging. Lu Chen D,Waheed Nadia K,Witkin Andre,Baumal Caroline R,Liu Jonathan J,Potsaid Benjamin,Joseph Anthony,Jayaraman Vijaysekhar,Cable Alex,Chan Kinpui,Duker Jay S,Fujimoto James G Ophthalmic surgery, lasers & imaging retina BACKGROUND AND OBJECTIVE:To demonstrate the feasibility of retinal and anterior segment intraoperative widefield imaging using an ultrahigh-speed, swept-source optical coherence tomography (SS-OCT) surgical microscope attachment. PATIENTS AND METHODS:A prototype post-objective SS-OCT using a 1,050-nm wavelength, 400 kHz A-scan rate, vertical cavity surface-emitting laser (VCSEL) light source was integrated to a commercial ophthalmic surgical microscope after the objective. Each widefield OCT data set was acquired in 3 seconds (1,000 × 1,000 A-scans, 12 × 12 mm for retina and 10 × 10 mm for anterior segment). RESULTS:Intraoperative SS-OCT was performed in 20 eyes of 20 patients. In six of seven membrane peels and five of seven rhegmatogenous retinal detachment repair surgeries, widefield retinal imaging enabled evaluation pre- and postoperatively. In all seven cataract cases, anterior imaging evaluated the integrity of the posterior lens capsule. CONCLUSIONS:Ultrahigh-speed SS-OCT enables widefield intraoperative viewing in the posterior and anterior eye. Widefield imaging visualizes ocular structures and pathology without requiring OCT realignment. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:94-102.]. 10.3928/23258160-20180129-03
    Dynamic intraoperative optical coherence tomography for inverted internal limiting membrane flap technique in large macular hole surgery. Lytvynchuk Lyubomyr M,Falkner-Radler Christiane I,Krepler Katharina,Glittenberg Carl G,Ahmed Daniel,Petrovski Goran,Lorenz Birgit,Ansari-Shahrezaei Siamak,Binder Susanne Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie BACKGROUND/OBJECTIVES:To assess the efficacy of dynamic intraoperative spectral-domain optical coherence tomography (iSD-OCT) imaging for inverted internal limiting membrane (ILM) flap technique (IILMFT) in large macular hole (MH) surgery. SUBJECTS/METHODS:Prospective, non-randomized, observational study was conducted on 8 eyes of 7 patients with large, chronic and recurrent MHs, which were treated by pars plana vitrectomy (PPV) with IILMFT. All patients underwent standard pre- and postoperative examination. The iSD-OCT imaging was performed using microscope integrated systems before, during, and after ILM peeling. The iSD-OCT data were post-processed using graphic software and reviewed for tissue behavior and instruments position. RESULTS:The real-time iSD-OCT-assisted IILMFT allowed for real-time imaging of the entire surgery with visualization of the MH, vitreoretinal instruments, and all steps of inverted ILM flap formation. In spite of shadowing created by the steel instruments, it was possible to follow and control the distance between the instrument tips and retinal layers. Dynamic imaging of the surgical maneuvers including ILM peeling and mechanical apposition of MH edges revealed the iatrogenic impact on the retina (depression and appearance of hyporeflective zones). iSD-OCT imaging could confirm the proper position of the inverted ILM flap at the very end of the surgery after fluid-air exchange. CONCLUSIONS:iSD-OCT imaging is an effective tool for learning and performing a well-controlled and safe inverted ILM flap technique in patients with large MH. Clinical significance of the structural iSD-OCT findings has to be further studied. 10.1007/s00417-019-04364-5
    Intraoperative optical coherence tomography findings during surgery for optic disc pit-associated maculopathy. Kang Hyun Goo,Park Sung Eun,Choi Eun Young,Lee Sung Chul,Kim Min International journal of ophthalmology 10.18240/ijo.2020.04.25
    [Intraoperative use of coherence tomography in vitreoretinal surgery]. Ramírez-Estudillo Juan Abel,Sánchez-Ramos Jorge Arturo,Pérez-Montaño Carla Rocío,González-Cortés Jesús Hernán Cirugia y cirujanos BACKGROUND:Optical coherence tomography is a useful tool in several diseases. Its intraoperative use with the intention of improving anatomical results has recently been described. PURPOSE:To determine the usefulness and safety of optical coherence tomography during pars plana vitrectomy for several vitreo-retinal diseases. MATERIAL AND METHODS:A prospective case series is reported, in which the decision that influenced the use of the optical coherence tomography imaging during pars plana vitrectomy is evaluated. A RESCAN 700 microscope that includes a spectral domain tomography was used to obtain the images. At the end of each procedure the surgeons completed a questionnaire to determine if the tomographic image had an influence when making decisions during the surgery, or change the decision during the procedure. RESULTS:Thirteen patients with pars plana vitrectomy were included, with cataract surgery also performed in 6 patients. The surgeon considered that the intraoperative image influenced the decision during the procedure in 8 cases. CONCLUSION:Intraoperative optical coherence tomography is helpful for a safe patient diagnosis. It does not affect the surgery time, and in some cases it is useful for optimising the procedure in vitreous-retinal surgery. 10.1016/j.circir.2016.04.002
    THE INTEGRATIVE SURGICAL THEATER: Combining Intraoperative Optical Coherence Tomography and 3D Digital Visualization for Vitreoretinal Surgery in the DISCOVER Study. Ehlers Justis P,Uchida Atsuro,Srivastava Sunil K Retina (Philadelphia, Pa.) 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. 10.1097/IAE.0000000000001999
    Analysis of pars plana vitrectomy for optic pit-related maculopathy with intraoperative optical coherence tomography: a possible connection with the vitreous cavity. Ehlers Justis P,Kernstine Kendal,Farsiu Sina,Sarin Neeru,Maldonado Ramiro,Toth Cynthia A Archives of ophthalmology (Chicago, Ill. : 1960) Optimal management of optic pit-related maculopathy remains to be determined. The fluid source for the maculopathy also remains controversial. In this article, we present a unique surgical technique for internal drainage of the intraretinal fluid and describe the intraoperative use of spectral-domain optical coherence tomography to assist in the surgical management of this condition. Pars plana vitrectomy was performed with elevation of the posterior hyaloid. Following an air-fluid exchange, aspiration over the optic nerve pit was performed. Following aspiration, intraoperative spectral-domain optical coherence tomography demonstrated collapse of the retinoschisis, strongly suggesting a connection between the vitreous cavity and the intraretinal fluid. 10.1001/archophthalmol.2011.316
    INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY -AVAILABLE TECHNOLOGIES AND POSSIBILITIES OF USE. A REVIEW. Benda T,Studený P Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti Optical coherence tomography (OCT) is a non-contact and non-invasive imaging and diagnostic method, that allows the imaging of ocular tissues on transverse sections in extremely high quality of micrometer resolution. The physical principle of OCT is analogous to ultrasound, but it uses infrared radiation instead of acoustic waves. By using a low coherent radiation source, it is possible to achieve a higher resolution. Based on the obtained data, the computer can reconstruct two or three-dimensional images of the examined tissue. In recent years, we have seen a rapid development in ophthalmic surgery, especially in surgical instruments and imaging methods. However, the technology of surgical microscopes does not change significantly and thus becomes a limiting factor in the development of ophthalmic microsurgery. The integration of the OCT into surgical microscopes, so the introduction of the Intraoperative Optical Coherence Tomography (iOCT), opens up further possibilities for displaying/looking at the operating field and adapting surgical techniques to the current situation during the surgery. On the contrary, the disadvantage is the prolongation of the surgery time and thus the theoretical increase in possible complications related to the surgery. iOCT can be used for operations on the anterior and posterior segment of the eye. In anterior segment surgery, it is used mostly in penetrating and lamellar keratoplasty, glaucoma surgery and cataract surgery. In posterior segment surgery, it is used during pars plana vitrectomy. The aim of the article is to provide a comprehensive overview of the current possibilities of using iOCT in eye surgery.
    HOLE-DOOR SIGN: A Novel Intraoperative Optical Coherence Tomography Feature Predicting Macular Hole Closure. Kumar Vinod,Yadav Bhupendra Retina (Philadelphia, Pa.) PURPOSE:To describe a novel intraoperative finding during pars plana vitrectomy for macular hole using operating microscope-integrated spectral domain optical coherence tomography that predicts the closure of macular hole. METHODS:Twenty-five eyes of 25 patients with macular hole, who underwent 25-gauge pars plana vitrectomy over a period of 16 months at a tertiary eye care center by a single surgeon, were recruited in this retrospective interventional study. All eyes were assessed with intraoperative spectral domain optical coherence tomography before and after internal limiting membrane peeling. The patients were assessed in terms of best-corrected visual acuity, preoperative minimal hole diameter, and type of hole closure. RESULTS:After the internal limiting membrane was peeled, vertical pillars of tissue were seen at the edges of hole projecting into the vitreous cavity. This appearance was similar to that of an open door over the macular hole and was termed "hole-door sign." Hole-door sign was seen in 15 of 25 eyes (60%). All the eyes with hole-door sign had Type-1 closure of macular hole (100%), whereas only 6 of 10 eyes (60%) without hole-door sign had Type-1 closure of the macular hole. CONCLUSION:Hole-door sign is a novel intraoperative finding that predicts postoperative Type-1 closure of macular hole. This may add to the utility of intraoperative optical coherence tomography in clinical practice. 10.1097/IAE.0000000000001791
    Optic disk pit morphology and retinal detachment: optical coherence tomography with intraoperative correlation. Gregory-Roberts Emily M,Mateo Carlos,Corcóstegui Borja,Schiff William M,Chang Louis K,Quiroz-Mercado Hugo,Park Sungpyo,Chang Stanley Retina (Philadelphia, Pa.) BACKGROUND:The pathogenesis of optic nerve head pits and associated retinal detachment, and the most effective surgical intervention when visual loss develops, remains unclear. METHODS:The morphology of the optic disk in patients with pits was investigated with optical coherence tomography. For those who underwent surgical treatment for pit-associated retinal detachment, the efficacy of treatment by vitrectomy and separation of the posterior hyaloid, with and without additional peeling of peripapillary tissue, was assessed. RESULTS:On optical coherence tomography imaging, 14 of 18 pits (78%) demonstrated a localized pit-like invagination, whereas 3 (17%) had disks with a generally excavated structure. For 16 of 18 pits (89%), there was evidence of condensed vitreous or glial tissue seen extending from the pit or inside the optic disk. Nine eyes with retinal detachment underwent vitrectomy, posterior hyaloid separation, and endolaser. The retinal detachment completely resolved in 6 of 6 cases where the surgeon additionally peeled the fibrous tissue from the pit and 2 of 3 cases where this was not performed. CONCLUSION:Spectral domain optical coherence tomography demonstrates the varying morphology of optic pit anatomy. Condensed vitreous strands or glial tissue in the optic nerve pit may also contribute to retinal detachment development. 10.1097/IAE.0b013e318263d0a6
    Intraoperative optical coherence tomography assisted analysis of pars Plana vitrectomy for retinal detachment in morning glory syndrome: a case report. Lytvynchuk Lyubomyr M,Glittenberg Carl G,Ansari-Shahrezaei Siamak,Binder Susanne BMC ophthalmology BACKGROUND:The pathogenesis of non-rhegmatogenous retinal detachment (non-RRD) associated with morning glory syndrome (MGS) is not established, as well as best surgical approach to treat RD. Our purpose was to analyse intraoperative optical coherence tomography data (iOCT) in all steps of pars plana vitrectomy (PPV) for non-RRD in MGS, in order to follow pathophysiological aspects of the disease and to understand the tissues behaviour during surgical workflow. CASE PRESENTATION:Intraoperative spectral domain optical coherent tomography (iSD-OCT) assisted PPV using Rescan 700 (Carl Zeiss Meditech, Jena, Germany) with epiretinal membrane (ERM) and internal retinal membrane (ILM) peeling, and air endotamponade was performed on the only eye of a 21 years old female with non-RRD associated with MGS. BCVA, pre-, intra- and postoperative OCT were performed along with standard ocular examination. iOCT video and snapshots were analysed intra- and postoperatively using post-processing approach using graphic software. The progression of non-RRD resulted in best corrected visual acuity (BCVA) decrease from 0.8 to 0.2. Triamcinolone enhanced iOCT imaging revealed strong vitreous traction and adhesion above the macula and optic disc. Internal limiting membrane was peeled under iOCT control to prevent the peeling of inner layers of the retinal schisis. No retinal break was detected, and only air endotamponade was performed. The retina reattached during first 4 weeks of follow-up with gradual resolution of intraretinal- and subretinal fluid, and remained stable in 12 months. BCVA improved to 0.8. CONCLUSION:Based on iSD-OCT findings we assume that non-RRD in this case of MGS is caused primarily by the vitreous traction with further possible formation of the retinal breaks. Retinal reattachment reached only with air endotamponade strongly advocates the tractional component of non-RRD and retinal schisis assotiated with MGS. Early PPV for central non-RRD and retinal schisis with the use of iOCT can be performed in more safe and controlled manner and has to be considered to reduce the risk of retinal break formation and to prevent the central vision loss. 10.1186/s12886-017-0533-0
    Intraoperative optical coherence tomography-assisted displacement of prepapillary membrane in eyes with optic disc pit maculopathy. Inoue Makoto,Koto Takashi,Hirakata Akito Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie PURPOSE:To determine the efficacy of displacing a prepapillary membrane during vitrectomy assisted by intraoperative optical coherence tomography (OCT) to treat eyes with optic disc pit maculopathy. METHOD:Pars plana vitrectomy was performed with 27-gauge instruments on 4 eyes of 4 consecutive patients for optic disc pit maculopathy with retinoschisis and foveal detachment. After creating a posterior vitreous detachment, the prepapillary membrane was made visible by brilliant blue G staining. The membrane was peeled from the central retinal vessel and inverted and placed over intraretinal clefts or stuffed into the optic disc pit. These procedures were guided by intraoperative OCT. A gas tamponade and peripapillary laser was not used. The preoperative and postoperative OCT images and surgical outcomes were evaluated. RESULT:Intraretinal clefts connected to an inner retinoschisis were detected at the edge of the optic disc pit in 3 eyes with intraoperative OCT and 2 eyes with preoperative OCT. The foveal detachment and retinoschisis were resolved completely in all 4 eyes at postoperative 13 to 15 months. The postoperative vision improved from 20/25 to 20/18 at the final examination in all eyes. CONCLUSION:Intraoperative OCT can detect intraretinal clefts at the edge of the optic disc pit, and the OCT images are helpful in guiding the peeling and placement of the prepapillary membrane to achieve anatomical and visual recovery. 10.1007/s00417-020-05047-2
    Intraoperative OCT of bilateral macular coloboma in a child with Down syndrome. Aziz Hassan A,Ruggeri Marco,Berrocal Audina M Journal of pediatric ophthalmology and strabismus A 3-year-old girl with Down syndrome presented with a macular lesion in both eyes. With intraoperative optical coherence tomography confirmation, the patient was diagnosed as having bilateral macular coloboma. These findings were previously reported in two patients with Down syndrome. The documentation of similar findings in three separate patients suggests that macular coloboma may be a rare ophthalmic pathology associated with Down syndrome. Moreover, optical coherence tomography imaging may be a useful adjunct in diagnosing macular coloboma in the pediatric population. 10.3928/01913913-20110712-03
    Microscope-integrated optical coherence tomography: A new surgical tool in vitreoretinal surgery. Jayadev Chaitra,Dabir Supriya,Vinekar Anand,Shah Urmil,Vaid Tania,Yadav Naresh Kumar Indian journal of ophthalmology Optical coherence tomography (OCT) has revolutionized imaging of ocular structures and various disease conditions. Though it has been used in the clinic for some decades, the OCT has only recently found its way into the operating theater. Early attempts at intraoperative OCT, hand-held and microscope mounted, have already improved our understanding of the surgical pathology and the role it might play in surgical decision-making. The microscope-integrated OCT now allows seamless, high-resolution, real-time imaging of surgical maneuvers from the incision to wound closure. Visualization of instruments and intraoperative tissue manipulation are possible with this in vivo modality and, therefore, help improve the outcome of surgery. In this article, we describe the advantages it offers during various vitreoretinal procedures. 10.4103/0301-4738.159865
    Portable optical coherence tomography in management of vitreoretinal diseases: current developments, indications, and implications. Huang Lynn L,Hirose Tatsuo Seminars in ophthalmology The advent of optical coherence tomography (OCT) technology has greatly enhanced our understanding of vitreoretinal diseases; it has become a routine diagnostic imaging method for the evaluation of vitreoretinal abnormalities and injuries in adult and pediatric patients. The use of OCT has recently been extended beyond the offices and clinics to perioperative and intraoperative settings. The new development in high-resolution and high-speed spectral domain OCT, along with the improvement in portability, has made the device more valuable than ever before. Our article summarizes the current development of the portable OCT devices in clinical, perioperative, and intraoperative settings in the management of vitreoretinal diseases. 10.3109/08820538.2012.708811
    Microscope-Integrated Optical Coherence Tomography Angiography in the Operating Room in Young Children With Retinal Vascular Disease. Chen Xi,Viehland Christian,Carrasco-Zevallos Oscar M,Keller Brenton,Vajzovic Lejla,Izatt Joseph A,Toth Cynthia A JAMA ophthalmology Importance:Intraoperative optical coherence tomography (OCT) has gained traction as an important adjunct for clinical decision making during vitreoretinal surgery, and OCT angiography (OCTA) has provided novel insights in clinical evaluation of retinal diseases. To date, these two technologies have not been applied in combination to evaluate retinal vascular disease in the operating suite. Objective:To conduct microscope-integrated, swept-source OCTA (MIOCTA) in children with retinal vascular disease. Design, Setting, and Participants:In this case report analysis, OCT imaging in pediatric patients, MIOCTA images were obtained during examination under anesthesia from a young boy with a history of idiopathic vitreous hemorrhage and a female infant with familial exudative vitreoretinopathy. Main Outcomes and Measures:Side-by-side comparison of research MIOCT angiograms and clinically indicated fluorescein angiograms. Results:In 2 young children with retinal vascular disease, the MIOCTA images showed more detailed vascular patterns than were visible on the fluorescein angiograms although within a more posterior field of view. The MIOCTA system allowed visualization of small pathological retinal vessels in the retinal periphery that were obscured in the fluorescein angiograms by fluorescein staining from underlying, preexisting laser scars. Conclusions and Relevance:This is the first report to date of the use of MIOCTA in the operating room for young children with retinal vascular disease. Further optimization of this system may allow noninvasive detailed evaluation of retinal vasculature during surgical procedures and in patients who could not cooperate with in-office examinations. 10.1001/jamaophthalmol.2017.0422
    Clinical utility of intraoperative optical coherence tomography. Khan Mehnaz,Ehlers Justis P Current opinion in ophthalmology PURPOSE OF REVIEW:To explore the clinical utility of intraoperative optical coherence tomography (iOCT) for the management of vitreoretinal conditions. RECENT FINDINGS:The role of iOCT in guiding surgical decision-making and surgical manipulations during vitreoretinal procedures has been evaluated by multiple studies. This imaging modality is emerging as a valuable asset during procedures for vitreoretinal interface disorders, retinal detachments, submacular surgeries and therapeutics, and in pediatric conditions such as retinopathy of prematurity. iOCT allows the surgeon to assess completion of surgical goals and to directly monitor the architectural impact of instrument-tissue interactions that may correlate with eventual prognosis. The technology has gone through numerous iterations with the eventual goal being the development of a user-friendly, efficient, and integrated system that provides surgeons with 'real-time' feedback during ophthalmic surgeries to allow for a comprehensive image-assisted vitreoretinal surgery platform. SUMMARY:The role of iOCT in ophthalmic surgery has been evolving with the help of ongoing research to define its utility in the operating room and to develop integrative technologies. Advancements in OCT-friendly surgical instrumentation and in integrative capabilities of this technology may help achieve more widespread adoption of this technology in the vitreoretinal surgical theater. Although the evidence appears clear that this technology impacts surgical decision-making, additional research is needed. However, further research is needed to determine the influence of this technology on overall patient outcomes. 10.1097/ICU.0000000000000258
    Clinical applications for intraoperative optical coherence tomography: a systematic review. Eye (London, England) 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. 10.1038/s41433-021-01686-9
    [Microscope-integrated intraoperative optical coherence tomography in examination of pediatric patients under anesthesia]. Siebelmann S,Bachmann B,Matthaei M,Horstmann J,Dietlein T,Lappas A,Scholz P,Cursiefen C Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft BACKGROUND:The therapeutic principle of examinations of children under general anaesthesia using microscope-integrated optical coherence tomography (MI-OCT) is presented. The aim was to assess novel indications as well as limitations for MI-OCT to enhance ophthalmological examinations of neonates and children under general anesthesia. METHODS:The study was based on a review of the literature from google.scholar.com and PubMed and our own data from a prospective study (Department for Ophthalmology, University of Cologne) of 14 children with anterior and posterior segment anomalies undergoing examinations under anesthesia. Patients were examined using a commercially available MI-OCT device. The study analyzed the general feasibility of MI-OCT for ophthalmological examination of children under general anesthesia for the anterior and posterior eye segments and the benefits of indications and intraoperative findings. RESULTS:The MI-OCT significantly enriched the examinations of children under general anesthesia and delivered additional information not visible with the surgical microscope. Even in situations with a limited anterior chamber view MI-OCT enabled estimation of distances, such as corneal thickness. In addition to influencing therapeutic decisions, in 12/14 children MI-OCT also enabled examination of the thickness of the nerve fibre layer of the optic nerve disc and the retina. CONCLUSION:The data presented here underline the benefit of the intraoperative MI-OCT in ophthalmological examinations of children under general anesthesia. In particular MI-OCT enables examinations of children with corneal opacification, if an ophthalmological examination under general anesthesia becomes necessary. 10.1007/s00347-018-0756-3
    Pediatric Vitreoretinal Surgery and Integrated Intraoperative Optical Coherence Tomography. Cai Sophie,Therattil Anthony,Vajzovic Lejla Developments in ophthalmology Intraoperative portable handheld and microscope-integrated OCT enhance the pediatric vitreoretinal surgeon's diagnostic abilities during examination under anesthesia and surgery, particularly in children who are challenging to examine preoperatively due to young age or ocular trauma. Improved OCT-guided visualization of vitreoretinal anatomic relationships has the potential to improve surgical safety and efficiency. In retinopathy of prematurity and other pediatric retinal vascular conditions, intraoperative OCT can be critical for distinguishing between retinoschisis and retinal detachment and highlighting abnormalities of the vitreoretinal interface that may contribute to development of tractional retinal detachments. During retinal detachment repair, intraoperative OCT aids identification of subtle retinal breaks, residual subretinal fluid, retained perfluorocarbon, preretinal membranes, and residual hyaloid, among other findings. In macular surgery, intraoperative OCT has demonstrated value in confirming completion or lack thereof of epiretinal and internal limiting membrane peeling and differentiating between lamellar and full-thickness macular holes. OCT-guided subretinal bleb formation and genetic vector delivery are critical to ensuring accurate localization of subretinal gene delivery for inherited retinal degenerations. Research on development of OCT-compatible surgical instruments, real-time three-dimensional volumetric OCT imaging, and integration with intraoperative OCT angiography are anticipated to further increase the utility of intraoperative OCT in pediatric vitreoretinal surgical decision-making. 10.1159/000511818