Intraoperative OCT

Abstract

Intraoperative optical coherence tomography (iOCT) is an emerging technology that provides real-time OCT data during the surgical procedure. Similar to how OCT transformed the management of ophthalmic and vitreoretinal conditions in the clinic, iOCT has the potential to change how surgeries are approached and what maneuvers are performed. iOCT systems have evolved over time. Portable systems were a transformative step in technology, but were limited by reproducibility, motion artifact, and ease of use. Microscope-mounting of portable systems significantly improved these challenges, but still required pausing surgery to obtain images. Microscope-integrated OCT systems are now available and enable real-time feedback on the anatomic changes that occur during surgical manipulation. Next-generation systems are incorporating swept-source technology and three-dimensional heads-up visual display. Large prospective studies have examined the feasibility and utility of iOCT in anterior and posterior segment surgeries. Overall, these studies found that iOCT contributes valuable knowledge to the surgeon and can change surgical decision-making in a significant number of cases. iOCT has been shown to have clinical utility for multiple indications. For the anterior segment, iOCT has been most studied in lamellar corneal procedures such as Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty. For posterior segment surgery, iOCT has been most studied in surgeries for vitreoretinal interface abnormalities that require membrane peeling, including epiretinal membranes and macular holes. iOCT can help guide decision-making by identifying when further membranes need to be peeled or surgical goals have been attained. More complicated surgeries, including for proliferative diabetic retinopathy, retinal detachments, and uveitis-related diagnoses, may also benefit from the use of iOCT. While iOCT is emerging as a valuable surgical adjuvant to ophthalmic surgery, more studies are needed to determine long-term outcomes. New advances, including improved instrumentation and tracking technology, as well as further integration of three-dimensional visualization, will enhance the iOCT surgical experience.