continued from page 16 positioning of the
scan, recording of line and cube scans,
tracking of scans, and review—from the
foot pedal. Alternately, these functions
can be controlled using the touchscreen
if data acquisition is also performed. A
vertical and horizontal OCT picture is
mirrored into the side and on the top of
the surgeon’s right ocular.
Both the standard surgical video
and simultaneous OCT video are visible on the screen. The device can be
used unaided for anterior segment surgery to measure corneal thickness, anterior chamber depth, iris thickness, and
chamber angle. It is suitable for observing and controlling steps in cataract surgery, including corneal/limbal incisions,
capsulorhexis, and dynamics of phaco-emulsification. Furthermore, the system
can detect residual viscoelastic and control the position of the lens implant during and at the end of surgery.
For posterior segment surgery, either
a corneal lens or a wide angle viewing
system (Resight) is necessary to gain
high-quality pictures. During surgery,
pre-retinal vitreous mobility and adhesions, the presence or absence of an
attached posterior hyaloid, pre-retinal membranes, or foveal destructions
(holes, thinning, edema or iNLOnl-loss,
sub-retinal fluid, neo-vascularization,
or hemorrhage) can be continuously
visualized. Tearing forces applied to the
optic nerve and retina can be detected,
controlled, and minimized. Scans of
sufficient quality can also be acquired
under gas, perfluorocarbon (PFCL), or
In addition to these currently available
commercial systems, others are being
developed. Bioptigen recently received
a $1.72 million grant from the U.S.
National Eye Institute (NEI; Bethesda,
MD) for development of microscope-
integrated intraoperative OCT technol-
ogy. In September 2014, Hiroko Ter-
asaki of Nagoya University Hospital
(Japan) presented prototype intraoper-
ative endoscopic OCT from NIDEK at
the Meeting of Club Jules-Gonin. Pro-
fessor Terasaki and her group have used
the handheld forward-imaging, 21-gauge
(820 μm diameter) needle endoscope for
ophthalmic OCT inspection of cornea,
lens, and vitreous removed from ex vivo
porcine eyes. The device proved able to
clearly image structures 2. 5 mm from
the probe tip, meaning that it proved
suitable for endoscopic inspections. The
idea is similar to work done by Han et
al., 6 but uses a 23G fiber.
All of these systems are examples of
a major shift in the application of OCT
for surgical guidance. Moving forward,
microscope-integrated examination sys-
tems will surely be used in ophthalmic
microsurgery with increasing frequency.
Integration of OCT in surgical microscopy adds considerable value without loss
of time or sterility. Use of the microscope’s
optical pathway and inclusion of OCT
imagery in the surgeon’s view enables
complete and seamless control. This is a
fabulous example of how new technology
can address familiar challenges. And, as is
often the case with new technology, further experience might enable detection
of yet-unrecognized processes—and thus
yield even greater results. «
The Ludwig Boltzmann Institute (LBI)
for Retinology and Biomicroscopic Lasersurgery (LBI) received an unrestricted
equipment grant by Carl Zeiss Meditec.
LBI received a research grant by Carl
Zeiss Meditec in 2011/2012. The author
declares no actual or potential conflicts
of interest in relation to this article.
1. Y. K. Tao, J. Ehlers, C. A. Toth, and J.
A. Izatt, Opt. Lett., 35, 3315–3317 (2010).
2. S. Binder, C. I. Falkner-Radler, C. I.
Hauger, H. Matz, and C. Glittenberg,
Retina, e-pub ahead of print (Jan. 26, 2011).
3. Zeiler et al., Acta Ophthalmol. Scan.
(2014); in print.
4. Falkner et al., Ophthalmology (2014); in
5. M. Esmaeelpour et al., Invest. Ophthalmol. Vis. Sci., 22, 55, 8, 5074–5080
(2014); doi: 10.1167/iovs.14-14646.
6. S. Han, M. V. Saunuic, J. Wu, M. Humayun, and C. Yang, J. Biomed. Opt., 13,
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