Die intraoperative optische Kohärenztomografie in der Netzhaut-Glaskörper-Chirurgie. Aktuelle Erfahrungen und Ausblick auf künftige Entwicklungsschritte

Zusammenfassung

Hintergrund Die hochauflösende optische Kohärenztomografie (OCT) ermöglicht eine kontrastreiche Bildgebung von Mikrostrukturen, die mit konventioneller Bildgebung nicht so detailliert darstellbar waren. Wir berichten über unsere Erfahrungen beim Einsatz der intraoperativen OCT (iOCT) in der vitreoretinalen Chirurgie.

Methoden 110 Patienten mit vitreoretinalen Erkrankungen (Makulaforamen, epiretinale Membranen, vitreomakulärem Traktionssyndrom, Ablatio und Glaskörperblutung) wurden unter Visualisierung mit dem im Mikroskop integrierten iOCT-Gerät operiert.

Ergebnisse Das iOCT liefert durch die Integration von Mikroskop und SD-OCT eine sofortige Visualisierung der „Region of Interest“ (ROI). Der Operateur erhält neben dem Mikroskopbild die intraoperative Darstellung aller Netzhautschichten, des Glaskörpers sowie der Instrument-Gewebe-Interaktion in Echtzeit und kann diese intraoperativ sofort verfügbare Information für die chirurgische Strategie nutzen.

Schlussfolgerung Bisher ist das iOCT nur als Standmikroskop erhältlich, es besitzt keine Messfunktion, keine Tracking-Funktion, und die Metallinstrumente verdecken den Scan. Künftig könnten transparente Instrumente, Tracking-Funktionen, ein Autofokus sowie eine noch bessere Auflösung eine optimierte, lückenlose, hochauflösende intraoperative OCT-Diagnostik in Echtzeit erlauben.

Abstract

Purpose High resolution optical coherence tomography (OCT) enables better visualization of ophthalmic microstructures than conventional imaging. When using an ophthalmic microscope, integrated optical coherence tomography (iOCT) high resolution real time visualization is possible.

Methods We report on the first 110 patients operated on using a microscope integrated OCT (iOCT) during surgical procedures for the treatment of various posterior segment pathologies.

Results Microstructural changes that appeared during surgery were depicted precisely by iOCT, and the morphology visualized before and after each surgical step was used to help deciding how to adapt the surgical flow. The iOCT data and real-time imaging of retinal anatomy gives the surgeon the possibility of deploying patient- and operation-specific interventional procedures.

Discussion To date, iOCT is only available in standing microscopes with no measurement or tracking features. Moreover, metal instruments currently obscure the scanned images. In the future, non-metal, transparent instruments (OCT-friendly surgical tools), tracking features, an autofocus and higher resolution could enable full and immediate intraoperative SD-OCT diagnostics in real time.

Schlüsselwörter

intraoperatives OCT - vitreoretinale Chirurgie - Makulachirurgie - vitreoretinales Interface

Key words

intraoperative OCT - vitreoretinal surgery - macular surgery - vitreoretinal interface

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