Intraoperative imaging of macular hole repair to predict visual function outcomes

低视力和失明影响了超过4000万美国人，估计每年的成本为250亿美元。 临床诊断和治疗。美国40岁及以上成人视力损害的患病率 美国高于3.5%，预计由于人口老龄化将显著增加。许多眼部疾病是 进行性的，需要在晚期进行手术治疗，这涉及到精确的操作， 眼睛中的微妙的半透明结构。光学相干断层扫描（OCT）已经彻底改变了 通过允许视网膜微结构的高分辨率非侵入性可视化来进行眼科成像， 成为临床诊断的“黄金标准”。然而，尽管术前OCT被广泛采用， 手术计划和预测结果，术后功能结果可能是高度可变的。黄斑 孔（MH）手术中，约90%的患者实现孔闭合和解剖正常化，但低至27%， 患者达到>20/40（法律的驾驶限制）的最佳矫正视力。我们假设（1）结构 MH修复过程中视网膜的变化是术后视功能的预后， 手术干预;（2）手术期间MH动力学的iOCT成像将能够量化基于图像的 生物标志物和识别导致功能不良的相应组织-仪器相互作用 结果;（3）了解手术操作与术后视力之间的因果关系 将有利于临床决策和新的手术技术和术中反馈机制 用于MH修复和其他眼部疾病。我们的工程师和临床医生的合作计划将 进行基础成像研究，以了解手术操作对患者的因果影响。 MH修复期间的术后视力恢复。为了克服当前一代iOCT系统的局限性， 我们开发了多模式光谱编码相干断层扫描和反射仪（SECTR）， 技术，允许同时和本质上共同登记的正面反射率和横截面 OCT成像。SECTR使用同时采集的光谱编码反射率（SER）正面和OCT交叉， 截面图像，以提供正交维度上的互补空间信息， 注册和跟踪。在后处理中分割运动校正的4D OCT数据集， 视网膜层的识别和由手术操作引起的组织变形的量化。 MH动力学（AIM 1）的自动跟踪和4D成像提供了前所未有的结构变化数据 已被证明可预测术后功能结局的手术操作 (AIM 2）。将在MH修复期间进行体内iSECTR成像，以了解因果关系 手术动力学和术后视觉功能（AIM 3）之间的关系，并可能导致新的图像引导 手术操作在此项目中开发的技术将在个性化领域有广泛的应用。 手术，预测结果，以及广泛的外科专业中的图像引导反馈。

Low vision and blindness affect over 40 million Americans and have an estimated annual cost of $25 billion for clinical diagnosis and treatment. The prevalence of visual impairment in adults 40 years and older in the United States is above 3.5% and expected to increase markedly due to population aging. Many ocular diseases are progressive and require surgical management at advanced stages, which involves precision manipulation of delicate semi-transparent structures in the eye. Optical coherence tomography (OCT) has revolutionized ophthalmic imaging by allowing for high-resolution noninvasive visualization of retinal microstructure and has become the “gold standard” for clinical diagnostics. However, despite broad adoption of preoperative OCT for surgical planning and predicting outcomes, postoperative functional outcomes may be highly variable. In macular hole (MH) surgery, ~90% of patients achieve hole closure and anatomic normalization but as low as 27% of patients achieve a best-corrected visual acuity of >20/40 (legal driving limit). We hypothesize that (1) structural changes in the retina during MH repair, which are prognostic of postoperative visual function, result directly from surgical intervention; (2) iOCT imaging of MH dynamics during surgery will enable quantification of image-based biomarkers and identification of corresponding tissue-instrument interactions that lead to poor functional outcomes; and (3) understanding the causal relationship between surgical manipulation and postoperative vision will benefit clinical decision-making and novel surgical technique and intraoperative feedback mechanism development for MH repair and other ocular diseases. Our collaborative program of engineers and clinicians will perform foundational imaging studies to understand the casual effects that surgical maneuvers have on postoperative vision recovery during MH repair. To overcome limitations of current-generation iOCT systems, we have developed multimodal spectrally encoded coherence tomography and reflectometry (SECTR) technologies that allows for simultaneous and intrinsically co-registered en face reflectance and cross-sectional OCT imaging. SECTR uses concurrently acquired spectrally encoded reflectance (SER) en face and OCT cross- sectional images to provide complementary spatial information in orthogonal dimensions and enable volumetric registration and tracking. Segmentation of motion-corrected 4D OCT datasets in post-processing has enabled retinal layer identification and quantification of tissue deformations resulting from surgical manipulation. Automated tracking and 4D imaging of MH dynamics (AIM 1) provides unprecedent data on structural changes resulting from surgical manipulation that have been shown to be predictive of postoperative functional outcomes (AIM 2). In vivo iSECTR imaging during MH repair will be performed to understand the causal relationship between surgical dynamics and postoperative visual function (AIM 3) and may lead to novel image-guided surgical maneuvers. Technologies developed during this project will have broad applications in personalized surgery, predicting outcomes, and image-guided feedback in a wide-range of surgical specialties.