Table 1. Definitions of Pathologies for Cross-Sectional SDOCT
Images in Figure 2.
History of OCT Imaging in Vitreoretinal SurgeryCynthia A. Toth,
M.D.Joseph AC Wadsworth Professor of OphthalmologyProfessor of
Biomedical Engineering
Royalties: Alcon, HemosonicsResearch Support: Genentech, NIH
Duke University Medical Center
Machemer R, Parel JM, Buettner H. A new concept for vitreous
surgery. 1. Instrumentation. AJO. 1972.
45 years since the invention of pars plana vitrectomy
Machemer R, Buettner H, Norton EW, Parel JM.Vitrectomy: a pars
plana approach.Trans AAOphth Otolar.1971.
Machemer R. Two instrument techniques in pars plana
vitrectomy.Arch Ophthalmol. 1974.Parel JM, Machemer R, Aumayr W. An
automated operating microscope.Am J Ophthalmol. 1974.
Pars plana vitreoretinal surgery required new tools and
techniques
While the tools have advancedThe microscope has lagged
behind
3
Operating without OCTOCT imaging has revolutionized pre and
postoperative assessment
The surgeon goes back to an en face OCT-free view during
surgery
Stage A. intraoperative iOCT:2D outside the microscope at a
pause in surgeryPortable imaging 2007Bioptigen research system
Vitreomacular tractionVitreous removedDayani PN, Maldonado R,
Farsiu S, Toth CA. Intraoperative use of HH SDOCT imaging in
macular surgery. Retina, 2009 Scott AW, Farsiu S, Enyedi LB,
Wallace DK, Toth CA. Imaging the infant retina with a HH SDOCT
device. AJO, 2009Ehlers JP, Kernstine K, Farsiu S, Sarin N,
Maldonado R, Toth CA. Analysis of pars plana vitrectomy for optic
pit-related maculopathy with intraoperative OCT. Arch Ophthalmol.
2011
Imaging over time intervals
Bioptigen Envisu
Stage B iOCT. Microscope integratedReal-time 2D scansView 3D
volumes at a pause in surgery or laterTao YK, Ehlers JP, Toth CA,
Izatt JA. Intraoperative SDOCT for vitreoretinal surgery. Optics
Letters, 2010.Ehlers JP, Tao YK, Farsiu S, Maldonado R, Izatt JA,
Toth CA. Integration of SDOCT into a surgical microscope for
intraoperative imaging. IOVS 2011Hahn P, Migacz J, O'Connell R,
Maldonado RS, Izatt JA, Toth CA. Use of OCT in intraoperative
ophthalmic imaging. OSLI 2011-Binder S; Falkner-Radler C, Hauger,
C; Matz H; Glittenberg, C. Feasibility of intrasurgical Spectral
domain optical coherence tomography Retina. 2011.
Duke/ Izatt- Bioptigen
Retinal imageB-Scan
Medical Univ. Vienna Binder-Carl Zeiss Meditech
Stage B iOCT: Real-time 2D OCT:Current Commercial MIOCTEhlers
JP, Goshe J, Dupps WJ, Kaiser PK, Singh RP, Gans R, Eisengart J,
Srivastava SK. Determination of feasibility and utility of MIOCT
during ophthalmic surgery: the DISCOVER Study RESCAN Results. JAMA
Ophthalmol. 2015
Monocular heads up displayto view 2D images
Bioptigen/LeicaEnFocus 2300
Integrated Scanner
Swept Source OCT (1060 nm)Up to 7.4 mm axial imaging range, 7.8
m axial resolution200 kHz A-line rateGPU-based Volumetric Image
Computation and Rendering Custom CUDA GPU pipeline for live
acquisition and processing Utilizes single nVidia GTX Titan Black
GPU Each group of 16 B-scans: 86 ms-acquire, 18 ms-process, and
12.5 ms-render
Stereo Heads up DisplayIn oculars or 3D screenStage C iOCT 4D
MIOCT System componentsOscar Carrasco-Zevallos
Yuankai Kenny Tao
Joseph Izatt
Liangbo Linus Shen
Stereo HUDTao YK et al Optics Letters 2010Carrasco-Zevallos et
al Nature Scientific Reports 2016Viehland C et al, Biomed. Opt.
Expr. 2016.Shen L et al Biomed Opt Express. 2016
Brenton KellerChristian Viehland
Stage C iOCT Integrated Components for Vitreoretinal Surgery
The next Stage of iOCT :Image-guided surgeryImprove Speed &
Quality of Imaging/RenderDisplay volumes faster Remove
ArtifactsStabilize systems
Intuitive Surgeon ControlControl of viewpointAugment RealityOCT
Angiography
Integrated heads-up display and true OCT-guided maneuvers are a
research realityMany opportunities for innovation for full surgeon
integration10
iOCT CollaboratorsOphthalmology Paul HahnLejla VajzovicDH Nam
Bozho TodorichMichael SeiderDilraj GrewalJustis Ehlers Ramiro
MaldonadoAdrienne ScottSai ChavalaPouya Dayani
Duke Advanced Research in SD/SSOCT Imaging (DARSI) Laboratory
(Toth)Pam BhullarRachelle OConnell Du Tran Viet Michelle
McCallNeeru SarinEric YuanMonica SevillaAlexandra DandridgeVincent
TaiAdam RothmanPhilip DesouzaBiomedical EngineeringJoseph
IzattOscar Carrasco-Zevallos Brenton KellerChristian Viehland Linus
ShenCrystal ChukwurahGar WatermanJustin Migicz
Fitzpatrick Center, Duke UniversityFundingNIH Biomedical
Research Partnership Grant R01-EY023039, Intraoperative OCT
Guidance of Intraocular Surgery" (Izatt/Toth MPI),
NCRR UL1 RR024128-01R21 EY019411Duke Advanced Imaging
LaboratorySina FarsiuStephanie ChiuDavid CunefareCole Eye Institute
Sunil SrivastavaJustis Ehlers BJ DuppsKenny TaoAnthony KuoNeel
PasrichaChristine ShiehRyan McNabb
11
