Intraoperative OCT – Real-World User Evaluation in Routine Surgery

Abstract

Background In recent years, great progress has been made in intraoperative imaging using optical coherence tomography (iOCT). There are now several commercially available iOCT systems that allow high-resolution imaging of all structures of the eye without interrupting surgery. This real-time visualisation can provide additional information to conventional surgical microscopy, but is relatively expensive. The aim of our study was to find out how often OCT integrated into the surgical microscope is used by trained surgeons, or to what extent they consider that iOCT is relevant for intraoperative procedures.

Patients and Methods A prospective monocentric analysis was conducted of the field of application and user-friendliness of the EnFocus Ultra-Deep OCT (Leica Microsystems), a mobile device combination of surgical microscope and OCT. The use and benefit were investigated of iOCT, which was not mandatory. Standardised documentation and evaluation using a questionnaire was performed by the respective surgeon (n = 5) immediately after surgery.

Results Over a period of 25 working days, 118 procedures were performed in the operating theatre equipped with the microscope-OCT combination. The iOCT was used in 24.6% of the 118 procedures performed. iOCT was regarded as crucial to the intraoperative procedure in 3 of the 29 patients. In one patient, it was possible to check graft orientation during a DMEK operation in a very opaque cornea and, in the second patient, to visualise the correct positioning of an iris diaphragm in the capsular bag. In the third patient, the risk of developing a pseudoforamen was assessed, and this led to the decision not to perform a full gliosis peel.

Conclusion Experienced surgeons in a university eye hospital with a full surgical spectrum considered that intraoperative OCT was decisive for the course of surgery in only a few selected surgical situations, e.g. in case of limited corneal transparency. The impact of the use of iOCT on post-operative outcome quality still needs to be evaluated by larger prospective studies. On the basis of this survey, the cost-benefit ratio is still unclear.

Key words

cataract - cornea - glaucoma - retina - iOCT

Publication History

Received: 30 December 2020

Accepted: 09 February 2021

Article published online:
20 May 2021

• References/Literatur

• 1 Geerling G, Müller M, Winter C. et al. Intraoperative 2-dimensional optical coherence tomography as a new tool for anterior segment surgery. Arch Ophthalmol 2005; 123: 253-257
• 2 Hayashi A, Yagou T, Nakamura T. et al. Intraoperative changes in idiopathic macular holes by spectral-domain optical coherence tomography. Case Rep Ophthalmol 2011; 2: 149-154
• 3 Steven P, Le Blanc C, Lankenau E. et al. Optimising deep anterior lamellar keratoplasty (DALK) using intraoperative online optical coherence tomography (iOCT). Br J Ophthalmol 2014; 98: 900-904
• 4 Au J, Goshe J, Dupps WJ. et al. Intraoperative Optical Coherence Tomography for Enhanced Depth Visualization in Deep Anterior Lamellar Keratoplasty From the PIONEER Study. Cornea 2015; 34: 1039-1043
• 5 Ehlers JP, Dupps WJ, Kaiser PK. et al. The Prospective Intraoperative and Perioperative Ophthalmic ImagiNg with Optical CoherEncE TomogRaphy (PIONEER) Study: 2-year results. Am J Ophthalmol 2014; 158: 999-1007
• 6 Ehlers JP, Modi YS, Pecen PE. et al. The DISCOVER Study 3-Year Results: Feasibility and Usefulness of Microscope-Integrated Intraoperative OCT during Ophthalmic Surgery. Ophthalmology 2018; 125: 1014-1027
• 7 Patel AS, Goshe JM, Srivastava SK. et al. Intraoperative Optical Coherence Tomography–Assisted Descemet Membrane Endothelial Keratoplasty in the DISCOVER Study: First 100 Cases. Am J Ophthalmol 2020; 210: 167-173
• 8 Pasricha ND, Shieh C, Carrasco-Zevallos OM. et al. Real-Time Microscope-Integrated OCT to Improve Visualization in DSAEK for Advanced Bullous Keratopathy. Cornea 2015; 34: 1606-1610
• 9 Lang SJ, Heinzelmann S, Böhringer D. et al. Indications for intraoperative anterior segment optical coherence tomography in corneal surgery. Int Ophthalmol 2020; 40: 2617-2625 DOI: 10.1007/s10792-020-01442-0.
• 10 Ham L, Balachandran C, Verschoor CA. et al. Visual rehabilitation rate after isolated Descemet membrane transplantation: Descemet membrane endothelial keratoplasty. Arch Ophthalmol 2009; 127: 252-255
• 11 Spaniol K, Borrelli M, Holtmann C. et al. Komplikationen der Descemetmembran-Endothel-Keratoplastik. Ophthalmologe 2015; 112: 974-981
• 12 Hos D, Tuac O, Schaub F. et al. Incidence and Clinical Course of Immune Reactions after Descemet Membrane Endothelial Keratoplasty: Retrospective Analysis of 1000 Consecutive Eyes. Ophthalmology 2017; 124: 512-518
• 13 Juthani VV, Goshe JM, Srivastava SK. et al. Association between transient interface fluid on intraoperative OCT and textural interface opacity after DSAEK surgery in the PIONEER study. Cornea 2014; 33: 887-892
• 14 Siebelmann S, Cursiefen C, Lappas A. et al. Intraoperative Optical Coherence Tomography Enables Noncontact Imaging During Canaloplasty. J Glaucoma 2016; 25: 236-238
• 15 Hattenbach LO, Framme C, Junker B. et al. [Intraoperative real-time OCT in macular surgery]. Ophthalmologe 2016; 113: 656-662
• 16 Hattenbach LO. Stellenwert der intraoperativen optischen Kohärenztomografie in der Netzhautchirurgie. Teil 1: pro. Klin Monbl Augenheilkd 2020; 237: 1220-1224
• 17 Maier M, Bohnacker S, Klein J. et al. Vitrektomie mit iOCT-assistierter invertierter ILM-Flap-Technik bei großen Makulaforamina. Ophthalmologe 2019; 116: 617-624
• 18 Ehlers JP, Uchida A, Srivastava SK. et al. Predictive Model for Macular Hole Closure Speed: Insights From Intraoperative Optical Coherence Tomography. Transl Vis Sci Technol 2019; 8: 18
• 19 Ehlers JP, Ohr MP, Kaiser PK. et al. Novel microarchitectural dynamics in rhegmatogenous retinal detachments identified with intraoperative optical coherence tomography. Retina 2013; 33: 1428-1434
• 20 Ehlers JP, Uchida A, Srivastava SK. Intraoperative optical coherence tomography-compatible surgical instruments for real-time image-guided ophthalmic surgery. Br J Ophthalmol 2017; 101: 1306-1308
• 21 Maier M, Hattenbach LO, Klein J. et al. Echtzeit-optische Kohärenztomographie-assistierte Hochpräzisionsvitreoretinalchirurgie in der klinischen Routine. Ophthalmologe 2020; 117: 158-165
• 22 Siebelmann S, Hermann M, Dietlein T. et al. Intraoperative Optical Coherence Tomography in Children with Anterior Segment Anomalies. Ophthalmology 2015; 122: 2582-2584