Intraocular OCT Real-time Monitoring of Laser Retinectomy

描述（由申请人提供）：眼科研究人员开创的激光手术和眼部相干断层扫描对目前诊断、理解、治疗和监测多种眼科疾病的能力产生了巨大的全球健康影响。将这两种强大的模式结合成一个微型眼内探头来监测和引导实时激光手术的潜力尚未开发。随着新器械的出现，外科手术结局将有所改善，以提高外科医生的技术精度。该项目提出，可以开发一种具有微型探头的系统，该系统监测组织层的实时切割，以保护下层组织免受损伤。为了实现精确的图像引导切口，定制的实时光谱域光学相干断层扫描（SDOCT）成像系统将与新型桌面6.1 <m中红外（IR）切割激光器相结合，通过微型20号原型探针进行输送。该技术将被开发并应用于视网膜切除术。切开邻近前部增生性玻璃体视网膜病变的视网膜以实现视网膜复位在技术上是具有挑战性的。随着糖尿病在人口中的日益流行以及简易爆炸装置造成的严重眼外伤，这种技术越来越经常地被采用。原型的初步评价将在人工分离的猪视网膜上进行。成像和激光光斑将在目标组织上重叠，以允许在切口进行到视网膜下腔时对组织层消融进行实时成像。当这种情况发生时，探针将移动到相邻位置，以允许继续切开视网膜，同时防止对下面的视网膜色素上皮的损伤。将对所有切口进行组织学检查，以评价热损伤，检查底层组织结构，并与SDOCT信号轮廓进行比较，以指导探头的修改，以实现最佳性能。在提案完成后，手持式组合SDOCT成像/ IR激光/透热疗法探头和系统将准备好在动物研究中进行验证。假设：可以开发具有微型探针的系统，其监测组织层的实时切口以保护下层组织免受损伤。艾姆岛红外激光波导探头和一种新型的SDOCT成像探头将被开发，然后结合成一个符合人体工程学的20号探头，用于眼内手术。Aim II.优化并证明SDOCT系统的可行性，以评价通过20号探针输送的人工分离视网膜的实时激光切割（视网膜切除术）。公共卫生相关性：其目标是通过将光成像技术与微型探针中的切割激光相结合来实现安全的图像引导切口。成像将被用来检测组织层的切口，因为它发生，以保护下面的结构免受伤害。这一概念将在视网膜眼内手术中进行探讨，但与多个手术领域有着深刻的相关性。

DESCRIPTION (provided by applicant): The pioneering of laser surgery and ocular coherence tomography by eye researchers has had a tremendous global health impact upon the current ability to diagnose, understand, treat, and monitor multiple eye diseases. The potential of combining these two powerful modalities into a miniature intraocular probe to monitor and guide real-time laser surgery is untapped. Advances in surgical outcomes will occur with new devices to increase the technical precision of surgeons. This project proposes that a system with a miniature probe can be developed that monitors real-time incision of a tissue layer to protect the underlying tissues from injury. To achieve precise image-guided incisions, a customized real-time spectral domain optical coherence tomography (SDOCT) imaging system will be combined with a novel table-top 6.1 <m mid-infrared (IR) incising laser for delivery through miniature 20-gauge prototype probes. This technology will be developed and applied to retinectomy. Incising retina adjacent to anteriorly located proliferative vitreoretinopathy to achieve retinal re- attachment is technically challenging. This technique is being more frequently employed with the increasing prevalence of uncontrolled diabetes in the population and the advent of severe ocular trauma from improvised explosive devices. Initial evaluation of the prototypes will occur on artificially detached porcine retinas. The imaging and lasing spots will overlap on the target tissue to permit real-time imaging of tissue layer ablation as the incision proceeds to the subretinal space. As this occurs, the probe will be moved to an adjacent location to permit continued incision of the retina while preventing damage to underlying retinal pigment epithelium. All incisions will be examined histologically to evaluate for thermal injury, to inspect underlying tissue structures, and to compare to the SDOCT signal profile in order to guide modification of the probes for optimal performance. Upon proposal completion, a hand-held combined SDOCT imaging/ IR laser/ diathermy probe and system will be ready to verify in an animal study. Hypothesis: A system with a miniature probe can be developed that monitors real-time incision of a tissue layer to protect the underlying tissues from injury. Aim I. An IR laser waveguide probe and a novel SDOCT imaging probe will be developed and then combined into an ergonomic 20-gauge probe for intraocular surgery. Aim II. Optimize and demonstrate feasibility of the SDOCT system to evaluate real-time laser incising of artificially detached retinas (retinectomy procedure) delivered through the 20-gauge probe. PUBLIC HEALTH RELEVANCE: The goal is to achieve safe image-guided incisions by combining light-imaging technology with an incising laser in a miniature probe. The imaging will be exploited to detect incision of a tissue layer as it occurs to protect the underlying structures from injury. This concept will be explored in a retinal intraocular procedure, but has profound relevance for multiple surgical areas.