title: Integrative advances for OCT-guided ophthalmic surgery and intraoperative OCT: microscope integration, surgical instrumentation, and heads-up display surgeon feedback.
abstract: OBJECTIVE
  To demonstrate key integrative advances in microscope-integrated intraoperative optical coherence tomography (iOCT) technology that will facilitate adoption and utilization during ophthalmic surgery.
  
  
  METHODS
  We developed a second-generation prototype microscope-integrated iOCT system that interfaces directly with a standard ophthalmic surgical microscope. Novel features for improved design and functionality included improved profile and ergonomics, as well as a tunable lens system for optimized image quality and heads-up display (HUD) system for surgeon feedback. Novel material testing was performed for potential suitability for OCT-compatible instrumentation based on light scattering and transmission characteristics. Prototype surgical instruments were developed based on material testing and tested using the microscope-integrated iOCT system. Several surgical maneuvers were performed and imaged, and surgical motion visualization was evaluated with a unique scanning and image processing protocol.
  
  
  RESULTS
  High-resolution images were successfully obtained with the microscope-integrated iOCT system with HUD feedback. Six semi-transparent materials were characterized to determine their attenuation coefficients and scatter density with an 830 nm OCT light source. Based on these optical properties, polycarbonate was selected as a material substrate for prototype instrument construction. A surgical pick, retinal forceps, and corneal needle were constructed with semi-transparent materials. Excellent visualization of both the underlying tissues and surgical instrument were achieved on OCT cross-section. Using model eyes, various surgical maneuvers were visualized, including membrane peeling, vessel manipulation, cannulation of the subretinal space, subretinal intraocular foreign body removal, and corneal penetration.
  
  
  CONCLUSIONS
  Significant iterative improvements in integrative technology related to iOCT and ophthalmic surgery are demonstrated.
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States of America.
authors.forename: Justis P
authors.initials: JP
authors.lastname: Ehlers
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States of America.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Srivastava
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States of America.
authors.forename: Daniel
authors.initials: D
authors.lastname: Feiler
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Amanda I
authors.initials: AI
authors.lastname: Noonan
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Rollins
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States of America; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America; Department of Ophthalmic Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States of America.
authors.forename: Yuankai K
authors.initials: YK
authors.lastname: Tao
mesh_terms: D000818:Animals; D006801:Humans; D008853:Microscopy / Q000295:instrumentation / Q000379:methods; D008866:Microsurgery / Q000295:instrumentation* / Q000379:methods; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods; D012160:Retina / Q000601:surgery; D034421:Sus scrofa; D041623:Tomography, Optical Coherence / Q000295:instrumentation* / Q000379:methods