Intraoperative OCT Guidance of Intraocular Surgery

项目摘要 这是一个生物工程研究合作伙伴关系（BRP）的重新提交申请， 一个高度协作和经验丰富的工程师和眼科医生团队，以推进国家的 图像引导外科手术的艺术。我们试图克服外科医生目前的立体声系统的局限性， 通过继续整合光学相干断层扫描（OCT）技术， 这在眼科实践中已经被广泛接受。在现代眼科 显微手术，有限的深度感知和眼睛内的数据容量， 限制了显微镜对外科医生的作用， 细微对比的结构限制了手术终点和患者结果的实现。 在过去的七年里，我们的团队开发了领先的眼科术中OCT程序， 手术在美国在最初的R21支持下，我们的第一代显微镜集成OCT（MIOCT）设计 能够在手术期间进行实时横截面成像，并且是多个 目前的商业供应商。我们目前的BRP资助的工作介绍了第一个活的“4D”（体积 通过时间成像）MIOCT技术，其以微米级分辨率在几个 每秒完全渲染的体积，外科医生可以从任意角度通过 一种新颖的立体平视显示器。我们已经证明并记录了这些性能 系统在杜克眼科中心的250多个真人眼科手术中使用，并记录了创新和结果 合作伙伴和其他团队在上一个BRP供资期发表的95多篇出版物和演讲中 成员 拟议的更新项目的总体目标是鼓励戏剧性的技术进步继续下去 外科医生驱动的实时4D MIOCT手术的改进，并增强OCT图像引导的实用性 通过改善手术环境的相关方面来进行显微手术。为此，我们将大幅增加 通过开发下一代OCT引擎技术， 一种新型的宽视野自动眼球跟踪MIOCT扫描仪。我们将赋予外科医生充分的 通过开发包括手术室在内的新型集成数据可视化， 高清3DTV和增强/虚拟现实头戴式显示器。每一项改进都是 基于当前黄斑和眼前节手术的具体需求， 我们完善的翻译方法，将多学科团队之间的迭代反馈 成员我们相信，这一发展不仅将改善目前手术的结果， 由于目前外科实践的限制，新的眼科和其他显微外科手术是不可能的。

PROJECT SUMMARY This is a resubmission application for a Bioengineering Research Partnership (BRP) which brings together a highly collaborative and experienced team of engineers and ophthalmic surgeons to advance the state of the art in image-guided surgical interventions. We seek to overcome limitations to the surgeon’s current stereo microscopic view of ocular structures by continuing to integrate optical coherence tomography (OCT) technology, which is already well accepted in ophthalmic practice, into the operating room. In modern ophthalmic microsurgery, the limited depth perception and capacity for data within oculars, the physically demanding constraints the microscope places on the surgeon, and the inability to distinguish delicate, microscopic tissue structures of subtle contrast limits achievement of surgical endpoints and patient outcomes. Over the past seven years, our team has developed the leading intra-operative OCT program in ophthalmic surgery in the US. Under initial R21 support, our first-generation microscope-integrated OCT (MIOCT) design enabled live cross-sectional imaging during surgery, and is the approach which has been adopted by multiple vendors in current commercial offerings. Our current BRP funded work introduced the first live “4D” (volumetric imaging through time) MIOCT technology which images microsurgery with micrometer-scale resolution at several fully rendered volumes per second, interactively viewable by the surgeon from an arbitrary perspective through a novel stereoscopic heads-up display. We have demonstrated and documented the performance of these systems in over 250 live human eye surgeries at the Duke Eye Center, with innovations and results documented in over 95 publications and presentations resulting from the prior BRP funding period by Partners and other team members. The overall goals of the proposed renewal project are to instigate dramatic technical advances to continue surgeon-driven improvement of live 4D MIOCT surgery, and to enhance the utility of OCT image-guided microsurgery by improving related aspects of the surgical milieu. To do this, we will significantly increase the speed and ease of use of intra-operative MIOCT by developing next-generation OCT engine technology coupled with a novel wide-field automated eye-tracking MIOCT scanner. We will empower surgeons to take full advantage of this new information by developing novel integrated data visualizations including operating room high-definition 3DTV and augmented/virtual reality head-mounted displays. Each of these improvements are motivated by specific current needs in both macular and anterior segment surgery, and will be developed through our well-established translational methodology of incorporating iterative feedback between multidisciplinary team members. We believe this developments will not only improve outcomes in current surgeries, but will also enable novel ophthalmic and other microsurgeries not possible due to current limitations in surgical practice.