Microscope-integrated systems future of intraoperative OCT, speaker says

PHILADELPHIA — Intraoperative optical coherence tomography may enhance surgeon experience and improve outcomes in vitreoretinal surgery, a speaker told colleagues here.

“Intraoperative OCT is currently feasible. New discoveries are achieved through this technology. It’s an emerging field with regard to application on scopes,” Justis P. Ehlers, MD, said at Macula 2014.

Currently, system incompatibility and cost hinder the use of intraoperative OCT, Ehlers said.

“There are significant hurdles to utilization. One is just integrated solutions, system portability and microscope integration. Cost is always a concern, whether it’s purchasing a system or even just loss of potential OR time,” he said. “Really understanding the clinical applications and how they can impact patient care is still unknown.”

Tabletop systems are difficult to transport between operating rooms. Hand-held probes are portable and versatile but lack scan repeatability and eye tracking, Ehlers said.

“All of these systems have significant limitations. It’s challenging to aim to the area of interest. It requires a pause during the surgical procedure, and it really doesn’t allow for real-time intraoperative OCT and still has an external display system,” Ehlers said.

Microscope-integrated OCT is most promising.

“This provides visualization of the true tissue-instrument interaction … and provides rapid scan localization to the area of interest with little or no change in surgical time,” Ehlers said.

Prototype microscope-integrated OCT systems are being developed at the Cleveland Clinic and Duke University and by Carl Zeiss Meditec. One commercially available integrated system from Haag-Streit is available in Europe.

Other challenges include visual display, instrumentation and software development, Ehlers said.

Disclosure: Ehlers owns intellectual property rights with Bioptigen.