Ophthalmic surgeons manipulate micron-scale tissues using stereopsis through an operating microscope and instrument
shadowing for depth perception. While ophthalmic microsurgery has benefitted from rapid advances in instrumentation
and techniques, the basic principles of the stereo operating microscope have not changed since the 1930’s. Optical
Coherence Tomography (OCT) has revolutionized ophthalmic imaging and is now the gold standard for preoperative and
postoperative evaluation of most retinal and many corneal procedures. We and others have developed initial microscope-integrated
OCT (MIOCT) systems for concurrent OCT and operating microscope imaging, but these are limited to 2D
real-time imaging and require offline post-processing for 3D rendering and visualization. Our previously presented 4D
MIOCT system can record and display the 3D surgical field stereoscopically through the microscope oculars using a
dual-channel heads-up display (HUD) at up to 10 micron-scale volumes per second. In this work, we show that 4D
MIOCT guidance improves the accuracy of depth-based microsurgical maneuvers (with statistical significance) in mock
surgery trials in a wet lab environment. Additionally, 4D MIOCT was successfully performed in 38/45 (84%) posterior
and 14/14 (100%) anterior eye human surgeries, and revealed previously unrecognized lesions that were invisible
through the operating microscope. These lesions, such as residual and potentially damaging retinal deformation during
pathologic membrane peeling, were visualized in real-time by the surgeon. Our integrated system provides an enhanced
4D surgical visualization platform that can improve current ophthalmic surgical practice and may help develop and
refine future microsurgical techniques.
Oscar Carrasco-Zevallos, Brenton Keller, Christian Viehland, Liangbo Shen, Bozho Todorich, Christine Shieh, Anthony Kuo, Cynthia Toth, and Joseph A. Izatt, "4D microscope-integrated OCT improves accuracy of ophthalmic surgical maneuvers," Proc. SPIE 9693, Ophthalmic Technologies XXVI, 969306 (Presented at SPIE BiOS: February 13, 2016; Published: 4 March 2016); https://doi.org/10.1117/12.2212857.
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