Evaluation of the Use of Intraoperative OCT in Routine Surgery: A Two-year Comparison

Abstract

Background In recent years, an increasing number of surgical microscopes fitted with an OCT module (intraoperative OCT, iOCT) have become available, providing high-resolution images of the surgical site in real time. While a 2018 survey at our hospital showed that iOCT delivered an additional intraoperative benefit in only 2.4% of all operations, considering that the manufacturer had since revised the hardware and software, we conducted a second user evaluation of this technology.

Material and Methods Prospective monocentric analysis of the application and user-friendliness of an EnFocus Ultra-Deep OCT (Leica Microsystems) over a period of 25 (2018) and 20 working days (2021). A standardized questionnaire was used to assess the surgeonsʼ use of iOCT and its influence on the surgical course.

Results 118 operations were performed over a 25-day period in 2018 and 92 operations were performed over a 20-day period in 2021. In 2018, iOCT was used in 24.6% and in 2021 in 48.9% of all surgeries, with iOCT proving to be “critical” to the surgical course in 2.4% and 3.3% of cases, respectively, as assessed by the surgeons in both years. These were operations in which the intraocular view was limited, e.g., with decompensated cornea, vitreous hemorrhage, or after previous surgery, e.g., after penetrating keratoplasty.

Conclusion Further development of the user interface led to an improvement in usability, and the iOCT was used significantly more often. In both years, the iOCT proved to be critical for the course of the surgery in a comparably small number of operations, especially those involving complex situations.

Fazitbox

Bereits bekannt:

• Über die hohe Wertigkeit und den Nutzen der intraoperativen OCT (iOCT) sowohl bei Vorder- als auch bei Hinterabschnittsoperationen wurde bereits mehrfach berichtet.

• Bislang ist jedoch unklar, in welchem Ausmaß dies im klinischen Alltag als wirklich nutzbringend und damit die hochpreisige Investition (6-stelliger Eurobetrag) als lohnend zu bewerten ist.

• Wir führten eine Nutzerevaluation mit identischem Studiendesign wie 2018 durch, wobei jedoch ein Nachfolgemikroskop mit veränderter Software und Hardware eingesetzt wurde.

Neu beschrieben:

• Die iOCT bietet Operateuren insbesondere in komplexen OP-Situationen (besonders bei schlechtem Einblick) im Vergleich zur alleinigen Betrachtung durch das klassische, koaxiale Mikroskop eine ergänzende Visualisierung.

• Durch die Weiterentwicklung der Nutzeroberfläche wurde eine Verbesserung der Bedienbarkeit erzielt und die iOCT deutlich häufiger verwendet. Die iOCT erwies sich aber in vergleichbar wenigen Operationen als verlaufsentscheidend.

Conclusion Box

Already known:

• There have already been multiple reports on the great value and benefits of OCT (iOCT) in both anterior and posterior segment operations.

• However, to date it is unclear to what extent this technology is beneficial in the everyday clinical setting, and whether it justifies the considerable investment required (the price in euros runs to six figures).

• We performed a user evaluation using the same study design as in 2018, but with a more recent microscope model that had different software and hardware.

Newly described:

• Especially in complex surgical situations (i.e. those with a poor view of the surgical site), iOCT offers surgeons enhanced visualization compared to what they can see using a conventional coaxial microscope.

• Further development of the user interface has made this technology more user friendly, clearly resulting in more frequent use of iOCT. However, the iOCT proved to be crucial to the surgical procedure in a comparably small number of cases.

Key words

ophthalmic surgery - intraoperative OCT - digital microscopy - user evaluation

Publication History

Received: 17 July 2022

Accepted: 06 November 2022

Article published online:
12 January 2023

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