Intraoperative OCT Guidance of Intraocular Surgery

项目概要 这是生物工程研究合作伙伴关系 (BRP) 的重新提交申请，该合作伙伴关系汇集了 一支由工程师和眼科医生组成的高度协作且经验丰富的团队，致力于推动眼科疾病的发展 图像引导外科手术的艺术。我们寻求克服外科医生当前立体声的局限性 通过继续集成光学相干断层扫描（OCT）技术，获得眼部结构的显微视图， 这已经在眼科实践中被广泛接受并进入手术室。在现代眼科 显微外科手术、眼内有限的深度感知和数据能力、对身体的要求 显微镜对外科医生的限制，以及无法区分精致的微观组织 微妙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，我们的团队开发了眼科领域领先的术中 OCT 项目 在美国做手术。在最初的 R21 支持下，我们的第一代显微镜集成 OCT (MIOCT) 设计 在手术过程中启用实时横截面成像，并且是多个已采用的方法 当前商业产品中的供应商。我们目前 BRP 资助的工作引入了第一个实时“4D”（体积 随时间成像）MIOCT 技术，可在数个微米级分辨率下对显微外科手术进行成像 每秒完全渲染的体积，外科医生可以从任意角度交互式查看 一种新颖的立体平视显示器。我们已经展示并记录了这些的性能 杜克眼科中心超过 250 例现场人眼手术的系统，记录了创新和结果 合作伙伴和其他团队在之前的 BRP 资助期间发表了超过 95 篇出版物和演示文稿 成员。 拟议更新项目的总体目标是推动重大技术进步，以继续 外科医生推动实时 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外科手术。为此，我们将大幅增加 通过开发下一代 OCT 引擎技术，提高术中 MIOCT 的速度和易用性 配备新型宽视场自动眼动追踪 MIOCT 扫描仪。我们将授权外科医生充分采取 通过开发新颖的集成数据可视化（包括手术室）来利用这些新信息 高清 3DTV 和增强/虚拟现实头戴式显示器。这些改进中的每一项都是 受到黄斑和眼前段手术当前特定需求的推动，并将通过 我们完善的转化方法结合了多学科团队之间的迭代反馈 成员。我们相信这一进展不仅会改善当前手术的结果，而且还将使 由于目前手术实践的限制，新型眼科手术和其他显微手术是不可能的。

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.