Intraoperative imaging of macular hole repair to predict visual function outcomes

黄斑裂孔修复术中成像以预测视功能结果

• 批准号: 10037117
• 负责人: Yuankai Kenny Tao
• 金额: $ 36.04万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10037117
• 关键词: 4D Imaging; Adoption; Adult; Affect; American; Anatomy; Automobile Driving; Blindness; Clinical; Clinical Research; Clinical Treatment; Cornea; Data; Data Set; Development; Diagnostic; Dimensions; Disease; Engineering; Eye; FDA approved; Feedback; Foundations; Generations; Gold; Image; Image-Guided Surgery; Inner Limiting Membrane; Lead; Legal; Link; Macular Hole; Measures; Methods; Microscope; Microscopy; Motion; Operative Surgical Procedures; Ophthalmology; Optical Coherence Tomography; Outcome; Patients; Photoreceptors; Postoperative Period; Prevalence; Process; Progressive Disease; Recovery; Research; Resolution; Retina; Retinal Photoreceptors; Sampling; Severities; Speed; Structure; Surgical Management; Surgical Specialties; Surrogate Markers; System; Techniques; Technology; Testing; Thick; Time; Tissues; Traction; Translating; Trauma; United States; Vision; Visual Acuity; Visual Fields; Visual impairment; Visualization; Vitrectomy; aging population; base; biomarker identification; clinical Diagnosis; clinical decision-making; clinical diagnostics; cost; data acquisition; data archive; density; digital imaging; follow-up; functional outcomes; image guided; imaging biomarker; imaging study; in vivo; instrument; instrumentation; interest; multimodality; novel; outcome prediction; prognostic; programs; repaired; standard of care; tomography

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.

低视力和失明影响着超过 4000 万美国人，估计每年造成 250 亿美元的损失 临床诊断和治疗。美国 40 岁及以上成年人视力障碍的患病率 各州的这一比例都在 3.5% 以上，并且由于人口老龄化预计将显着增加。很多眼部疾病都是 渐进性的，需要在晚期阶段进行手术治疗，其中涉及对 眼睛中精致的半透明结构。光学相干断层扫描 (OCT) 发生了革命性的变化 通过允许视网膜微结构的高分辨率无创可视化来进行眼科成像，并具有 成为临床诊断的“金标准”。然而，尽管术前 OCT 被广泛采用 手术计划和预测结果、术后功能结果可能存在很大差异。在黄斑部 孔 (MH) 手术中，约 90% 的患者实现孔闭合和解剖正常化，但只有 27% 的患者实现孔闭合和解剖正常化。 患者的最佳矫正视力>20/40（法定驾驶限制）。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，直接由 手术干预； (2) 手术期间 MH 动态的 iOCT 成像将能够对基于图像的 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 将有利于临床决策以及新颖的手术技术和术中反馈机制 MH 修复和其他眼部疾病的开发。我们的工程师和临床医生合作计划将 进行基础影像学研究，以了解手术操作对患者的偶然影响 MH 修复期间术后视力恢复。为了克服当前一代 iOCT 系统的局限性， 我们开发了多模态光谱编码相干断层扫描和反射测量（SECTR） 允许同时和本质上共同配准正面反射率和横截面的技术 OCT 成像。 SECTR 使用同时采集的正面光谱编码反射率 (SER) 和 OCT 交叉光谱 剖面图像以提供正交维度的补充空间信息并启用体积 注册和跟踪。后处理中运动校正 4D OCT 数据集的分割已启用 视网膜层识别和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 由手术操作产生的结果已被证明可以预测术后功能结果 （目标 2）。将在 MH 修复过程中进行体内 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，可能会导致新的图像引导 外科手术操作。该项目期间开发的技术将在个性化领域具有广泛的应用 手术、预测结果以及各种外科专业的图像引导反馈。