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Intraoperative OCT system may improve posterior, anterior segment surgeries
Investigator discusses benefits and surgeon feedback of one of the first commercially available iOCT systems.
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A spectral-domain OCT system integrated into a surgical microscope may improve the quality of posterior and anterior segment procedures, according to a study.
In recent years, several research groups have developed similar devices to allow the use of OCT intraoperatively. The devices are intended to gain instant feedback of ophthalmic surgical maneuvers in the anterior and posterior segments. The technology can be used in surgical settings such as full-thickness macular hole, optic pit maculopathy, epiretinal membrane and retinopathy of prematurity.
“The added benefit is that you have instant feedback of your surgical performance and on morphology. Where is the membrane located that you want to peel? Where is a good cleavage plane to grasp? Especially for macular surgery I think there are many benefits to the instant feedback,” lead investigator Matthias D. Becker, MD, PhD, MSc, told Ocular Surgery News.
The retrospective single-center case series, published in Ophthalmic Surgery, Lasers and Imaging Retina, evaluated initial clinical experience of the Rescan 700 intraoperative OCT system (iOCT, Carl Zeiss Meditec) in 40 consecutive cases.
System review
A standardized review was used to assess whether the system resulted in additional information for the surgeon and whether the system altered decision making.
The time burden was an average of 2 minutes 36 seconds, which could lead to fewer anesthesia-related problems, the study authors said.
Average imaging time varied: 117 seconds for anterior segment surgeries, 128 seconds for posterior segment surgeries and 182 seconds for combined procedures.
There were two instances of additional information gain and no cases of altered decision making in the nine anterior segment surgeries.
iOCT imaging provided additional information in 23 of the 31 posterior segment or combined surgeries, with 13 cases resulting in altered decision making.
The system was also usable when combined with chromovitrectomy dyes and tamponades.
As a limitation, iOCT cannot see the inner limiting membrane because it is too thin; therefore, a dye would be needed.
“There are many more patients and anterior segment surgery, so there is clearly a big benefit for corneal surgery or cataract surgery. It can image the iris as well,” Becker said.
Learning curve
Becker recommended the iOCT system for a more experienced surgeon because it takes some time to get used to the incorporation of the foot pedal.
“When you’re used to the system, you don’t have to move your head from the oculars or you don’t need an additional person to install the system, you can start it with your own foot. But it takes a while to really train your foot and know what to do and where to look,” he said.
Becker thinks the most difficult aspect to get used to is the simultaneous action of using the system while performing surgery.
“Many surgeons in the beginning do surgery and then make a picture and then go back to surgery, but with this system you can do a live iOCT image simultaneously while you’re working, and that needs some training to look at the iOCT while you’re performing surgery,” he said.
In the future, Becker said a higher resolution and the possibility of quantifying distances and having the ability to go back to the same point in a previous surgery are additional qualities the iOCT can improve upon to continue its extended use in anterior and posterior segment procedures. – by Kristie L. Kahl
- Reference:
- Pfau M, et al. Ophthalmic Surg Lasers Imaging Retina. 2015;doi:10.3928/23258160-20151027-03.
- For more information
- Matthias D. Becker, MD, PhD, MSc, can be reached at the Department of Ophthalmology, Stadtspital Triemli Zürich, Birmensdorferstrasse 497, CH-8063 Zürich, Switzerland; email: matthias.becker@triemli.zuerich.ch.
Disclosure: Becker reports no relevant financial disclosures.
Perspective
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Justis P. Ehlers, MD
In this report, Pfau and colleagues provide an overview of their initial experience with the Rescan 700 microscope-integrated intraoperative OCT system (Zeiss) with a retrospective study of 40 consecutive cases. In this manuscript, the authors report that intraoperative OCT provided significant additional information to surgeons in more than 70% of posterior segment cases and actually altered surgical decision making in more than 40% of cases. These findings are consistent with the previously published PIONEER and DISCOVER intraoperative OCT studies. Interestingly, the authors describe decreased impact of intraoperative OCT in anterior segment procedures compared with previous studies. However, as the authors discuss, the vast majority (88%) of anterior cases were cataract procedures. This is in stark contrast to previous published studies, which focused primarily on the impact of intraoperative OCT with lamellar keratoplasty procedures, such as DMEK, DSAEK and DALK. Overall, the authors manuscript provides continued evidence for the potential for intraoperative OCT in ophthalmic surgery. Continued research is needed to better understand the overall impact of intraoperative OCT on long-term patient outcomes.
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