title: Four-dimensional microscope- integrated optical coherence tomography to enhance visualization in glaucoma surgeries.
abstract: We report the first use of swept-source microscope-integrated optical coherence tomography (SS-MIOCT) capable of live four-dimensional (4D) (three-dimensional across time) imaging intraoperatively to directly visualize tube shunt placement and trabeculectomy surgeries in two patients with severe open-angle glaucoma and elevated intraocular pressure (IOP) that was not adequately managed by medical intervention or prior surgery. We performed tube shunt placement and trabeculectomy surgery and used SS-MIOCT to visualize and record surgical steps that benefitted from the enhanced visualization. In the case of tube shunt placement, SS-MIOCT successfully visualized the scleral tunneling, tube shunt positioning in the anterior chamber, and tube shunt suturing. For the trabeculectomy, SS-MIOCT successfully visualized the scleral flap creation, sclerotomy, and iridectomy. Postoperatively, both patients did well, with IOPs decreasing to the target goal. We found the benefit of SS-MIOCT was greatest in surgical steps requiring depth-based assessments. This technology has the potential to improve clinical outcomes.
authors.affiliation: Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Neel Dave
authors.initials: ND
authors.lastname: Pasricha
authors.affiliation: Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Paramjit Kaur
authors.initials: PK
authors.lastname: Bhullar
authors.affiliation: Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Shieh
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Viehland
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC, USA.
authors.forename: Oscar Mijail
authors.initials: OM
authors.lastname: Carrasco-Zevallos
authors.affiliation: Department of Biomedical Engineering, Duke University, Durham, NC, USA.
authors.forename: Brenton
authors.initials: B
authors.lastname: Keller
authors.affiliation: Department of Ophthalmology, Duke University School of Medicine; Department of Biomedical Engineering, Duke University, Durham, NC, USA.
authors.forename: Joseph Adam
authors.initials: JA
authors.lastname: Izatt
authors.affiliation: Department of Ophthalmology, Duke University School of Medicine; Department of Biomedical Engineering, Duke University, Durham, NC, USA.
authors.forename: Cynthia Ann
authors.initials: CA
authors.lastname: Toth
authors.affiliation: Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Pratap
authors.initials: P
authors.lastname: Challa
authors.affiliation: Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Anthony Nanlin
authors.initials: AN
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000000981:diagnostic imaging*; D005901:Glaucoma / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007429:Intraocular Pressure; D008297:Male; D025321:Surgery, Computer-Assisted / Q000379:methods*; D041623:Tomography, Optical Coherence / Q000379:methods*; D014130:Trabeculectomy / Q000379:methods*