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    Using microscope-integrated intraoperative OCT in VR surgery

    Information obtained in real-time may change how vitreoretinal surgery is performed

     

     

    Cleveland—Intraoperative optical coherence tomography (OCT) that works in real-time can be an invaluable resource for surgeons, said Justis Ehlers, MD.

    However, the optimal platform for OCT integration into ophthalmic surgery remains unknown, said Dr. Ehlers, a staff physician on the vitreoretinal service of the Cole Eye Institute, Department of Ophthalmology, Cleveland Clinic.

    Discover study

    Dr. Ehlers and colleagues are conducting a prospective, multisurgeon, single-center study—the DISCOVER Study—examining the use of multiple microscope-integrated prototypes with real-time surgeon feedback through a heads-up display system, including the Rescan 700 (which is built into the Lumera 700 platform, Carl Zeiss Meditec) and a Cole Eye Institute iOCT System. The DISCOVER Study evaluated both anterior and posterior segment surgery.

    “The Rescan 700 is a prototype microscope-integrated iOCT system that is based on the Lumera 700 platform that includes heads-up display of the OCT data stream for the surgeon,” said Dr. Ehlers, who discussed the vitreoretinal surgery component.

    The interim 4-month analysis included 114 eyes (78 of which presented with vitreoretinal surgery needs). Average age was 61 years, and 47% of the patients were male.

    Intraoperative OCT image acquisition was achieved in 77/78 eyes that underwent vitreoretinal surgery (99%). Surgical indications included epiretinal membranes, macular holes, vitreomacular traction, retinal detachment, and IOL subluxation. Of those eyes, 45 (58%) were phakic, 29 (37%) were pseudophakic, and four (5%) were aphakic.

    Retinal detachment and epiretinal membrane were the most frequent diagnoses (23% and 31%, respectively). Vitreoretinal imaging was accomplished with both non-contact wide-angle and a contact lens viewing system.

    Heads-up display system

    “Initially, surgeons may have challenges adapting to the heads-up display system while performing particularly delicate manueuvers,” Dr. Ehlers said, but he believes this is primarily attributed to the typical learning curve rather than a true deterrent to the system.

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