Real-time intraoperative spectral domain optical coherence tomography for vitreoretinal surgery

摘要

Vitreoretinal surgery visualization is inherently limited by the ability to distinguish between tissues with subtle contrast, and to judge the location of an object relative to other retinal substructures. Inherent issues in visualizing thin translucent tissues, in contrast to underlying semitransparent ones, require the use of stains such as indocyanine green, which is toxic to retinal tissue. Spectral domain optical coherence tomography (SDOCT) has demonstrated strong clinical success in retinal imaging, enabling high-resolution, motion-artifact-free cross-sectional imaging and rapid accumulation of volumetric macular datasets. Current generation SDOCT systems achieve <5 μm axial resolutions in tissue, and have been used to obtain high resolution datasets from patients with various retinopathies. While OCT imaging has been considered for various non-ophthalmic intrasurgical applications, it is uniquely suited for vitreoretinal surgery where multiple layers of the retinal structure are readily accessible, and where high resolution cross-sectional viewing can have an impact on surgery as it is performed today. Real-time cross-sectional OCT imaging would also provide critical information relevant to the location and deformation of structures that may shift during surgery. Here, we demonstrate an opto-mechanical design for an intraoperative microscope-mounted OCT system (MMOCT) and preliminary in vivo human retinal imaging using this system in a test subject. By adapting an Oculus Binocular Indirect Ophthalmo-Microscope (BIOM3) suspended from a Leica microscope with SDOCT scanning and relay optics, we have demonstrated real-time cross-sectional imaging of multiple layers of the retinal structure, allowing for SDOCT augmented intrasurgical microscopy for intraocular visualization.