The Prospective Intraoperative and Perioperative Ophthalmic ImagiNg with Optical CoherEncE TomogRaphy (PIONEER) Study: 2-year results
Justis P Ehlers, William J Dupps, Peter K Kaiser, Jeff Goshe, Rishi P Singh, Daniel Petkovsek, Sunil K Srivastava, Justis P Ehlers, William J Dupps, Peter K Kaiser, Jeff Goshe, Rishi P Singh, Daniel Petkovsek, Sunil K Srivastava
Abstract
Purpose: To evaluate the feasibility, safety, and utility of intraoperative optical coherence tomography (OCT) for use during ophthalmic surgery.
Design: Prospective, consecutive case series.
Methods: A prospective, single-center, consecutive case series was initiated to assess intraoperative OCT in ophthalmic surgery. Intraoperative scanning was performed with a microscope-mounted spectral-domain OCT system. Disease-specific or procedure-specific imaging protocols (eg, scan type, pattern, size, orientation, density) were used for anterior and posterior segment applications. A surgeon feedback form was recorded as part of the study protocol to answer specific questions regarding intraoperative OCT utility immediately after the surgical procedure was completed.
Results: During the first 24 months of the PIONEER study, 531 eyes were enrolled (275 anterior segment cases and 256 posterior segment surgical cases). Intraoperative OCT imaging was obtained in 518 of 531 eyes (98%). Surgeon feedback indicated that intraoperative OCT informed surgical decision making and altered surgeon understanding of underlying tissue configurations in 69 of 144 lamellar keratoplasty cases (48%) and 63 of 146 membrane peeling procedures (43%). The most common anterior segment surgical procedure was Descemet stripping automated endothelial keratoplasty (DSAEK, n = 135). Vitrectomy with membrane peeling was the most common procedure for posterior segment surgery (n = 154). The median time that surgery was paused to perform intraoperative OCT was 4.9 minutes per scan session. No adverse events were specifically attributed to intraoperative OCT scanning during the procedure.
Conclusions: Intraoperative OCT is feasible for numerous anterior and posterior segment ophthalmic surgical procedures. A microscope-mounted intraoperative OCT system provided efficient imaging during operative procedures. The information gained from intraoperative OCT may impact surgical decision making in a high frequency of both anterior and posterior segment cases.
Copyright © 2014 Elsevier Inc. All rights reserved.
Figures
Microscope-mounted portable spectral domain optical coherence tomography system (circle).
Anterior segment intraoperative optical coherence tomography in lamellar keratoplasty. Intraoperative optical coherence tomography (OCT) B-scan following insertion of graft (dashed arrow) reveals partial apposition with persistent interface fluid (solid arrows) between the graft and the host cornea (arrowhead) during Descemet stripping automated endothelial keratoplasty surgery (Top). Intraoperative OCT B-scan during deep anterior lamellar keratoplasty surgery allows for visualization of edge of full-thickness cornea (dashed arrows) and bare Descemet membrane (solid arrows) following stromal dissection (Bottom).
Anterior segment intraoperative optical coherence tomography in lamellar keratoplasty. Intraoperative optical coherence tomography (OCT) B-scan following insertion of graft (dashed arrow) reveals partial apposition with persistent interface fluid (solid arrows) between the graft and the host cornea (arrowhead) during Descemet stripping automated endothelial keratoplasty surgery (Top). Intraoperative OCT B-scan during deep anterior lamellar keratoplasty surgery allows for visualization of edge of full-thickness cornea (dashed arrows) and bare Descemet membrane (solid arrows) following stromal dissection (Bottom).
Anterior segment intraoperative optical coherence tomography in lamellar keratoplasty. Intraoperative optical coherence tomography (OCT) B-scan following insertion of graft (dashed arrow) reveals partial apposition with persistent interface fluid (solid arrows) between the graft and the host cornea (arrowhead) during Descemet stripping automated endothelial keratoplasty surgery (Top). Intraoperative OCT B-scan during deep anterior lamellar keratoplasty surgery allows for visualization of edge of full-thickness cornea (dashed arrows) and bare Descemet membrane (solid arrows) following stromal dissection (Bottom).
Anterior segment intraoperative optical coherence tomography in lamellar keratoplasty. Intraoperative optical coherence tomography (OCT) B-scan following insertion of graft (dashed arrow) reveals partial apposition with persistent interface fluid (solid arrows) between the graft and the host cornea (arrowhead) during Descemet stripping automated endothelial keratoplasty surgery (Top). Intraoperative OCT B-scan during deep anterior lamellar keratoplasty surgery allows for visualization of edge of full-thickness cornea (dashed arrows) and bare Descemet membrane (solid arrows) following stromal dissection (Bottom).
Anterior segment intraoperative optical coherence tomography during corneal and cataract surgery. Intraoperative optical coherence tomography (OCT) B-scan following insertion of INTACS implant (dashed outline) confirms location (Top left). Intraoperative OCT B-scan during cataract extraction and intraocular lens placement verifies optimal location of IOL (solid arrow) behind the anterior capsule (dashed arrow). Irregularity and undulations in the posterior capsule (arrowhead) are visualized (Bottom left). Intraoperative OCT B-scan of clear corneal wound (solid arrows) with associated wound gape is visualized (Top right). Intraoperative OCT B-scan at different location of same corneal incision reveals a capsular remnant (solid arrows) within the wound resulting in wound gape (Bottom right).
Anterior segment intraoperative optical coherence tomography during corneal and cataract surgery. Intraoperative optical coherence tomography (OCT) B-scan following insertion of INTACS implant (dashed outline) confirms location (Top left). Intraoperative OCT B-scan during cataract extraction and intraocular lens placement verifies optimal location of IOL (solid arrow) behind the anterior capsule (dashed arrow). Irregularity and undulations in the posterior capsule (arrowhead) are visualized (Bottom left). Intraoperative OCT B-scan of clear corneal wound (solid arrows) with associated wound gape is visualized (Top right). Intraoperative OCT B-scan at different location of same corneal incision reveals a capsular remnant (solid arrows) within the wound resulting in wound gape (Bottom right).
Epiretinal membrane surgery and intraoperative optical coherence tomography. Preincision intraoperative optical coherence tomography (OCT) B-scan reveals epiretinal membrane (ERM, arrows, top left) and attached posterior hyaloid attached (arrows) at the optic nerve (Bottom left). Intraoperative OCT B-scan following membrane peeling and hyaloid elevation identifies residual ERM (arrow, top right) and confirms hyaloid release from the optic nerve with minimal residual hyaloid elements (arrows, bottom right).
Epiretinal membrane surgery and intraoperative optical coherence tomography. Preincision intraoperative optical coherence tomography (OCT) B-scan reveals epiretinal membrane (ERM, arrows, top left) and attached posterior hyaloid attached (arrows) at the optic nerve (Bottom left). Intraoperative OCT B-scan following membrane peeling and hyaloid elevation identifies residual ERM (arrow, top right) and confirms hyaloid release from the optic nerve with minimal residual hyaloid elements (arrows, bottom right).
Epiretinal membrane surgery and intraoperative optical coherence tomography. Preincision intraoperative optical coherence tomography (OCT) B-scan reveals epiretinal membrane (ERM, arrows, top left) and attached posterior hyaloid attached (arrows) at the optic nerve (Bottom left). Intraoperative OCT B-scan following membrane peeling and hyaloid elevation identifies residual ERM (arrow, top right) and confirms hyaloid release from the optic nerve with minimal residual hyaloid elements (arrows, bottom right).
Epiretinal membrane surgery and intraoperative optical coherence tomography. Preincision intraoperative optical coherence tomography (OCT) B-scan reveals epiretinal membrane (ERM, arrows, top left) and attached posterior hyaloid attached (arrows) at the optic nerve (Bottom left). Intraoperative OCT B-scan following membrane peeling and hyaloid elevation identifies residual ERM (arrow, top right) and confirms hyaloid release from the optic nerve with minimal residual hyaloid elements (arrows, bottom right).
Macular hole surgery and intraoperative optical coherence tomography. Preincision intraoperative optical coherence tomography (OCT) B-scan provides visualization of baseline ellipsoid zone to retinal pigment epithelium (EZ-RPE) distance (solid arrows) and full-thickness macular hole (arrowhead, top). Following internal limiting membrane (ILM) peeling, intraoperative OCT reveals focal full-thickness retinal elevation (arrowhead) and generalized expansion of the EZ-RPE distance (solid arrows, middle). Extrafoveal B-scan in same eye following ILM peeling identifies residual curled ILM (dashed arrow) and similar expansion of the EZ-RPE distance (solid arrow, bottom).
Macular hole surgery and intraoperative optical coherence tomography. Preincision intraoperative optical coherence tomography (OCT) B-scan provides visualization of baseline ellipsoid zone to retinal pigment epithelium (EZ-RPE) distance (solid arrows) and full-thickness macular hole (arrowhead, top). Following internal limiting membrane (ILM) peeling, intraoperative OCT reveals focal full-thickness retinal elevation (arrowhead) and generalized expansion of the EZ-RPE distance (solid arrows, middle). Extrafoveal B-scan in same eye following ILM peeling identifies residual curled ILM (dashed arrow) and similar expansion of the EZ-RPE distance (solid arrow, bottom).
Macular hole surgery and intraoperative optical coherence tomography. Preincision intraoperative optical coherence tomography (OCT) B-scan provides visualization of baseline ellipsoid zone to retinal pigment epithelium (EZ-RPE) distance (solid arrows) and full-thickness macular hole (arrowhead, top). Following internal limiting membrane (ILM) peeling, intraoperative OCT reveals focal full-thickness retinal elevation (arrowhead) and generalized expansion of the EZ-RPE distance (solid arrows, middle). Extrafoveal B-scan in same eye following ILM peeling identifies residual curled ILM (dashed arrow) and similar expansion of the EZ-RPE distance (solid arrow, bottom).
Retinal detachment and intraoperative optical coherence tomography. B-scan image following perfluorocarbon liquid tamponade reveals persistent subretinal fluid (solid arrow), outer retinal corrugations (arrowhead), and the hyperreflective signal of the retina/perfluorocarbon liquid interface (dashed arrow)
Vitreomacular traction intraoperative optical coherence tomography. Preincision intraoperative optical coherence tomography (OCT) B-scan revealing prominent foveal traction (arrow) and partially separated posterior hyaloid (arrowhead, top). Intraoperative OCT B-scan following hyaloid elevation reveals resolution of the traction with resultant occult full-thickness macular hole (arrows, bottom).
Vitreomacular traction intraoperative optical coherence tomography. Preincision intraoperative optical coherence tomography (OCT) B-scan revealing prominent foveal traction (arrow) and partially separated posterior hyaloid (arrowhead, top). Intraoperative OCT B-scan following hyaloid elevation reveals resolution of the traction with resultant occult full-thickness macular hole (arrows, bottom).
Source: PubMed