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相干断层扫描技术对当前诊断、理解、治疗和监测多种眼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指导实时激光手术的潜力尚未开发。随着新设备的出现，外科医生的技术精度也会有所提高。本项目提出了一种微型探头系统，可以实时监测组织层的切口，以保护底层组织免受伤害。为了实现精确的图像引导切割，定制的实时光谱域光学相干断层扫描（SDOCT）成像系统将与新型台式6.1 <m中红外（IR）切割激光器相结合，通过微型20号原型探头进行输送。该技术将被开发并应用于视网膜切除术。在前位增殖性玻璃体视网膜病变旁切入视网膜以实现视网膜再附着在技术上具有挑战性。随着人口中不受控制的糖尿病的日益流行和简易爆炸装置造成的严重眼外伤的出现，这种技术正被更频繁地采用。原型的初步评估将在人工分离的猪视网膜上进行。成像点和激光点将重叠在目标组织上，以便在切口进入视网膜下间隙时实时成像组织层消融。当这种情况发生时，探针将被移动到邻近的位置，以允许继续切割视网膜，同时防止损伤底层视网膜色素上皮。所有切口都将进行组织学检查，以评估热损伤，检查底层组织结构，并与SDOCT信号剖面进行比较，以指导修改探针以获得最佳性能。提案完成后，手持式SDOCT成像/红外激光/透热探针和系统将准备在动物研究中进行验证。假设：可以开发一个带有微型探针的系统，实时监测组织层的切口，以保护底层组织免受伤害。目的一：研制一种红外激光波导探头和一种新型的SDOCT成像探头，并将其结合成一种符合人体工程学的20口径眼内手术探头。目的二世。优化并论证了SDOCT系统通过20号探针实时激光切割人工离体视网膜（视网膜切除术）的可行性。公共卫生相关性：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，实现安全的图像引导切口。成像将用于检测组织层的切口，因为它发生以保护底层结构免受伤害。这一概念将在视网膜眼内手术中探讨，但对多个手术领域具有深远的意义。

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.