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.

Keywords: Diagnostic tests/Investigation; Imaging; Treatment Surgery.

Conflict of interest statement

Competing Interests: The following competing interests may be relevant to this publication: JE-Bioptigen (P); PK-Carl Zeiss Meditec (C), Alcon (C); SS-Bausch and Lomb (C); Bioptigen (P).

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1

RESCAN 700. (A) Microscope integrated intraoperative OCT system, the RESCAN 700 (*) with simultaneous display monitor revealing OCT data stream (red arrow) and surgeon oculars with heads-up display (yellow arrow). (B) Similar image with full view of RESCAN 700 with the heads-up display in surgeon oculars (yellow arrow) and Callisto display monitor with OCT feedback (red arrow).

Figure 2

Anterior segment intraoperative OCT (iOCT) with real-time feedback. (A) Surgical view of subluxed anterior chamber intraocular lens (ACIOL) with haptic trapped in corneal wound. (B) B-scan with iOCT feedback identifying elevated ACIOL (white arrowheads) and entrapment of haptic in corneal wound (red arrow). (C) Surgical view following ACIOL repositioning with B-scan crosshairs visible on display. (D) B-scan with iOCT feedback confirming optimal ACIOL position (white arrowheads) with haptic in the sulcus resting on the iris (yellow arrow). Residual corneal gap is present and identified (*). (E) Surgical view during phacoemulsification following groove formation. (F) B-scan of iOCT revealing grove depth (yellow arrow) and lens edge at groove (white arrows).

Figure 3

Posterior segment intraoperative OCT (iOCT). (A) Surgical view following triamcinolone installation to visualize the hyaloid. (B) B-scan following OCT contrast enhancement with triamcinolone with excellent visualization of the posterior hyaloid (orange arrow) and attachment at the optic nerve (red arrow). Underlying retina is shadowed due to density of triamcinolone (yellow arrow). (C) Surgical view following internal limiting membrane (ILM) peeling with 5-line raster display. (D) Following ILM peeling, iOCT reveals persistence of the retinal flap and full-thickness macular hole (yellow arrow).

Figure 4

Visualizing the impact of surgical maneuvers. (A) Surgical view with crosshairs of OCT scanner following elevation of the posterior hyaloid in a vitreomacular traction (VMT) case. (B) B-scan following hyaloid elevation in VMT case reveals occult full-thickness macular hole (yellow arrow), altering surgical planning (e.g., internal limiting membrane peeling, gas tamponade). (C) Surgical view of diamond dusted membrane scraper initiating membrane peel. (D) Real-time visualization with intraoperative OCT of instrument tissue-interaction (red arrow). Indocyanine green staining results in shadowing of underlying tissue and enhanced visualization of the internal limiting membrane (orange arrow).

Figure 5

Visualizing instrument-tissue interactions. (A) Surgical view with OCT crosshairs near forceps engaging the internal limiting membrane (ILM). (B) Intraoperative OCT (iOCT) of forceps (red arrow). Metallic material results in absolute shadowing of the underlying tissues (orange arrow). (C) Surgical view of forceps actively peeling the ILM. (D) iOCT revealing ILM (yellow arrow) with focal traction and the internal retinal surface (orange arrow).