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VISUALIZATION FROM INTRAOPERATIVE SWEPT-SOURCE MICROSCOPE-INTEGRATED OPTICAL COHERENCE TOMOGRAPHY IN VITRECTOMY FOR COMPLICATIONS OF PROLIFERATIVE DIABETIC RETINOPATHY

Gabr, Hesham, MD, MSc*,†; Chen, Xi, MD*; Zevallos-Carrasco, Oscar M., PhD; Viehland, Christian; Dandrige, Alexandria*; Sarin, Neeru, MD*; Mahmoud, Tamer H., MD, PhD*; Vajzovic, Lejla, MD*; Izatt, Joseph A., PhD; Toth, Cynthia A., MD*,‡

doi: 10.1097/IAE.0000000000002021
Original Study

Purpose: To evaluate the use of live volumetric (4D) intraoperative swept-source microscope-integrated optical coherence tomography in vitrectomy for proliferative diabetic retinopathy complications.

Methods: In this prospective study, we analyzed a subgroup of patients with proliferative diabetic retinopathy complications who required vitrectomy and who were imaged by the research swept-source microscope-integrated optical coherence tomography system. In near real time, images were displayed in stereo heads-up display facilitating intraoperative surgeon feedback. Postoperative review included scoring image quality, identifying different diabetic retinopathy-associated pathologies and reviewing the intraoperatively documented surgeon feedback.

Results: Twenty eyes were included. Indications for vitrectomy were tractional retinal detachment (16 eyes), combined tractional-rhegmatogenous retinal detachment (2 eyes), and vitreous hemorrhage (2 eyes). Useful, good-quality 2D (B-scans) and 4D images were obtained in 16/20 eyes (80%). In these eyes, multiple diabetic retinopathy complications could be imaged. Swept-source microscope-integrated optical coherence tomography provided surgical guidance, e.g., in identifying dissection planes under fibrovascular membranes, and in determining residual membranes and traction that would benefit from additional peeling. In 4/20 eyes (20%), acceptable images were captured, but they were not useful due to high tractional retinal detachment elevation which was challenging for imaging.

Conclusion: Swept-source microscope-integrated optical coherence tomography can provide important guidance during surgery for proliferative diabetic retinopathy complications through intraoperative identification of different complications and facilitation of intraoperative decision making.

In this study, the authors described the use of live volumetric intraoperative swept-source microscope-integrated optical coherence tomography in surgery for complications of proliferative diabetic retinopathy. Swept-source microscope-integrated optical coherence tomography can provide important guidance during surgery for proliferative diabetic retinopathy complications through intraoperative identification of different pathologies and facilitation of intraoperative decision making.

*Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina;

Department of Ophthalmology, Ain Shams University, Cairo, Egypt; and

Department of Biomedical Engineering, Duke University, Durham, North Carolina.

Reprint requests: Hesham Gabr, MD, MSc, Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Road, Durham, NC 27705; e-mail: hesham.gabr@duke.edu

Supported by a grant from the National Institutes of Health, R01-EY023039 (J. A. Izatt and C. A. Toth). Support was also provided through a 2-year vitreoretinal research fellowship funded by the Egyptian government (H. Gabr).

C. A. Toth reported receiving royalties through her university from Alcon. J. A. Izatt reported being chairman and chief scientific advisor for Bioptigen, Inc (since acquired by Leica Microsystems), and holding corporate, equity, and intellectual property interests (including royalties) in this company. J. A. Izatt and C. A. Toth are inventors on issued and pending patents pertaining to the technology described in this article. The remaining authors have no conflicting interests to disclose.

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© 2018 by Ophthalmic Communications Society, Inc.