title: Optical Coherence Tomography for Retinal Surgery: Perioperative Analysis to Real-Time Four-Dimensional Image-Guided Surgery.
abstract: Magnification of the surgical field using the operating microscope facilitated profound innovations in retinal surgery in the 1970s, such as pars plana vitrectomy. Although surgical instrumentation and illumination techniques are continually developing, the operating microscope for vitreoretinal procedures has remained essentially unchanged and currently limits the surgeon's depth perception and assessment of subtle microanatomy. Optical coherence tomography (OCT) has revolutionized clinical management of retinal pathology, and its introduction into the operating suite may have a similar impact on surgical visualization and treatment. In this article, we review the evolution of OCT for retinal surgery, from perioperative analysis to live volumetric (four-dimensional, 4D) image-guided surgery. We begin by briefly addressing the benefits and limitations of the operating microscope, the progression of OCT technology, and OCT applications in clinical/perioperative retinal imaging. Next, we review intraoperative OCT (iOCT) applications using handheld probes during surgical pauses, two-dimensional (2D) microscope-integrated OCT (MIOCT) of live surgery, and volumetric MIOCT of live surgery. The iOCT discussion focuses on technological advancements, applications during human retinal surgery, translational difficulties and limitations, and future directions.
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States.
authors.forename: Oscar M
authors.initials: OM
authors.lastname: Carrasco-Zevallos
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States.
authors.forename: Brenton
authors.initials: B
authors.lastname: Keller
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States.
authors.forename: Christian
authors.initials: C
authors.lastname: Viehland
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States.
authors.forename: Liangbo
authors.initials: L
authors.lastname: Shen
authors.affiliation: Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States.
authors.forename: Michael I
authors.initials: MI
authors.lastname: Seider
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States 2Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Izatt
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States 2Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Toth
mesh_terms: D006801:Humans; D008866:Microsurgery / Q000379:methods; D016343:Monitoring, Intraoperative / Q000379:methods*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D059035:Perioperative Period; D012164:Retinal Diseases / Q000175:diagnosis / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D041623:Tomography, Optical Coherence / Q000379:methods*