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PUBLICATION EXCLUSIVE: Visualization during surgery continues to evolve

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Intraoperative OCT is showing promise as a useful adjunct, especially in vitrectomy and lamellar keratoplasty. However, indications are limited, as vitrectomy only represents about 2% of ophthalmic surgical procedures in the U.S., or about 250,000 procedures per year. Endothelial and lamellar anterior keratoplasty represent only 0.25% of procedures, or about 30,000 per year.

In vitrectomy, early adopter surgeons are finding intraoperative OCT helpful when peeling epiretinal membranes and treating other vitreoretinal interface pathologies. Intraoperative OCT can help differentiate retinoschisis from retinal detachment. It is also potentially helpful in select surgical procedures to repair macular hole and retinal detachment and treat retinopathy of prematurity. In particular, those vitreoretinal surgeons who are training residents and fellows have found it to be a valuable teaching tool. For the corneal surgeon, it can help scan for interface fluid and delineate tissue planes in Descemet’s stripping endothelial keratoplasty, Descemet’s membrane endothelial keratoplasty, pre-Descemet’s endothelial keratoplasty and deep anterior lamellar keratoplasty.

Several manufacturers, including Carl Zeiss Meditec, Haag-Streit, Leica, Optovue and Heidelberg Engineering, are investing human and financial capital, hoping to make operating microscope-integrated intraoperative OCT a routine part of eye surgery. To achieve this goal, intraoperative OCT must find a routine indication in the most frequent surgical procedure in ophthalmology, cataract surgery. Our femtosecond laser-assisted cataract surgery (FLACS) procedures are OCT driven, but FLACS is currently infrequently utilized and requires a separate surgical work station.

I can easily imagine an ophthalmic surgery work station of the future in which real-time OCT is integrated into the operating microscope and therapeutic laser is also delivered through the same optics. Such an ophthalmic work station will almost certainly become available in the next decade.

• Click here to read the full publication exclusive, Lindstrom's Perspective, published in Ocular Surgery News U.S. Edition, August 10, 2017.