title: Intrasurgical Human Retinal Imaging With Manual Instrument Tracking Using a Microscope-Integrated Spectral-Domain Optical Coherence Tomography Device.
abstract: OBJECTIVE
  To characterize the first in-human intraoperative imaging using a custom prototype spectral-domain microscope-integrated optical coherence tomography (MIOCT) device during vitreoretinal surgery with instruments in the eye.
  
  
  METHODS
  Under institutional review board approval for a prospective intraoperative study, MIOCT images were obtained at surgical pauses with instruments held static in the vitreous cavity and then concurrently with surgical maneuvers. Postoperatively, MIOCT images obtained at surgical pauses were compared with images obtained with a high-resolution handheld spectral-domain OCT (HHOCT) system with objective endpoints, including acquisition of images acceptable for analysis and identification of predefined macular morphologic or pathologic features.
  
  
  RESULTS
  Human MIOCT images were successfully obtained before incision and during pauses in surgical maneuvers. MIOCT imaging confirmed preoperative diagnoses, such as epiretinal membrane, full-thickness macular hole, and vitreomacular traction and demonstrated successful achievement of surgical goals. MIOCT and HHOCT images obtained at surgical pauses in two cohorts of five patients were comparable with greater than or equal to 80% correlation in 80% of patients. Real-time video-imaging concurrent with surgical manipulations enabled, for the first time using this device, visualization of dynamic instrument-retina interaction with targeted OCT tracking.
  
  
  CONCLUSIONS
  MIOCT is successful for imaging at surgical pauses and for real-time image guidance with implementation of targeted OCT tracking. Even faster acquisition speeds are currently being developed with incorporation of a swept-source MIOCT engine. Further refinements and investigations will be directed toward continued integration for real-time volumetric imaging of surgical maneuvers.
  
  
  CONCLUSIONS
  Ongoing development of seamless MIOCT systems will likely transform surgical visualization, approaches, and decision-making.
authors.affiliation: Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Hahn
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC, USA.
authors.forename: Oscar
authors.initials: O
authors.lastname: Carrasco-Zevallos
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Cunefare
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Migacz
authors.affiliation: Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA ; Department of Biomedical Engineering, Duke University, Durham, NC, USA.
authors.forename: Sina
authors.initials: S
authors.lastname: Farsiu
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Izatt
authors.affiliation: Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA ; Department of Biomedical Engineering, Duke University, Durham, NC, USA.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Toth
keywords: OCT; human imaging; intraoperative; microscope-integrated; microscope-mounted; real-time; spectral-domain optical coherence tomography; tracking; vitreoretinal surgery