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Intraoperative OCT enhances surgical decision-making
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VIENNA —Microscope-integrated intraoperative OCT provides valuable feedback and significantly impacts decision-making during surgery, according to a study.
In the age of ubiquitous imaging in the management of ophthalmic diseases, taking OCT technology to the operating room may be the next paradigm shift, Justis Ehlers, MD, said at the American Society of Retina Specialists meeting.
Justis Ehlers
The DISCOVER study evaluated the feasibility and utility of real-time intraoperative optical coherence tomography (iOCT) using prototype systems at the Cole Eye Institute, Cleveland, Ohio. A total of 154 eyes with different retinal pathologies were included. A surgeon-feedback questionnaire was used to elicit information regarding use, impact on decision-making and ergonomics of the systems across the procedures.
“In membrane peeling, iOCT revealed residual membrane in 16% of cases and conversely confirmed complete membrane peel in 20%,” Ehlers said.
In retinal detachment surgery, it changed the understanding of the anatomy and clinical situation, thus impacting surgical approach in 22% of the cases.
“Examples included identification of optimal drainage site, discrimination of choroidal from subfoveal fluid and identification of full-thickness macular hole,” Ehlers said.
Following hyaloid elevation, an unroofed cyst or macular hole was identified in 21% of cases and resulted in alterations in surgical maneuvers in 14% of cases.
Concerning the ergonomics, surgeons found that iOCT provided valuable feedback in 66% of the procedures and altered the surgical procedure in 34% of the cases, aborting need for indocyanine green staining, requiring less surgery or more peeling. A minority of surgeons reported negative interference with surgical management.
No specific adverse events were attributed to the use of iOCT. — by Michela Cimberle
Disclosure: Ehlers reports he is a consultant to Zeiss, Leica/Surgical One, Bioptigen and Synergetics.