Intraoperative Optical Coherence Tomography for Ophthalmic Surgical Guidance

导致低视力和失明的主要原因，包括白内障、青光眼、老年性黄斑 变性、角膜营养不良和糖尿病视网膜病变，影响着4000多万美国人，并有 估计每年用于临床诊断和治疗的费用为250亿美元。儿童视力损害的患病率 美国40岁及以上的成年人比例超过3.5%，预计将显著上升，原因是 人口老龄化。尽管最近的几项研究已经证明了术中OCT(IOCT)对 验证手术目标的完成情况，当前未使用实时IOCT反馈来指导眼科手术 由于当前一代IOCT技术的几个基本限制：(1)连续横截面 OCT不能提供足够的空间位置和方位反馈来指导手术。(2)视频率 体积OCT在采样密度与视场和小静态OCT场的一致对准之间进行权衡 在外科手术期间，要到达感兴趣的区域是非常困难的。(3)体积OCT联合配准 手术视野的数据具有挑战性，因为不均匀的照明经常会使基准混淆。 和手术显微镜的对比。(4)实时体OCT可视化是复杂和耗时的， 需要横截面飞行或遮挡地下特征的计算代价高昂的渲染。 我们最近开发了多模术中光谱编码相干断层扫描和反射术 (ISECTR)技术，允许同时和内在地共同配准EN表面反射和交叉 断层OCT成像。我们假设(1)来自手术动力学的4D iSECTR的成像数据将受益 手术决策并导致改善功能结果；以及(2)成像、配准、 使用平视显示器(HUD)可视化的细分和反馈将增强现有功能并实现新功能 外科手术。我们已经组建了一个由工程师和临床医生组成的多学科团队来执行 基础的体外和体内成像研究，以(1)定量评估4D iSECTR的安全性和实用性- 基于手术反馈；以及(2)开发新的技术、反馈机制和动作，以 集成用于图像引导眼科手术的体积iSECTR数据。组织的全面4D成像- 器械相互作用动力学(AIM 1)为外科手术引起的结构变化提供了前所未有的数据 可预测术后功能结果并实现基于图像的询问的操作 生物力学和个性化的手术计划。实时手术可视化和引导(AIM 2)可以 提高传统外科手术的成功率以及下一代基因和干细胞 治疗。图像引导手术也可能与机器人辅助和远程操控兼容，在广泛的 眼科以外的外科专业。术中影像定量分析 性能、实用性和临床价值(AIM 3)将推动未来的技术开发和临床采用。

The leading causes of low vision and blindness, which include cataract, glaucoma, age-related macular degeneration, corneal dystrophy, and diabetic retinopathy, 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. Although several recent studies have demonstrated the utility of intraoperative OCT (iOCT) for verifying completion of surgical goals, real-time iOCT feedback is not currently used to guide ophthalmic surgery because of several fundamental limitations of current-generation iOCT technology: (1) Serial cross-sectional OCT does not provide sufficient spatial position and orientation feedback to guide surgery. (2) Video-rate volumetric OCT trades-off sampling density with field-of-view and consistent alignment of small static OCT fields to regions-of-interest is prohibitively difficult during surgical maneuvers. (3) Co-registration of volumetric OCT data with the surgical field is challenging because fiducials are often confounded by the non-uniform illumination and contrast of surgical microscopy. (4) Real-time volumetric OCT visualization is complex and time-consuming, requiring cross-sectional fly-throughs or computationally expensive renderings that occlude subsurface features. We recently developed multimodal intraoperative spectrally encoded coherence tomography and reflectometry (iSECTR) technologies that allows for simultaneous and intrinsically co-registered en face reflectance and cross- sectional OCT imaging. We hypothesize that (1) imaging data from 4D iSECTR of surgical dynamics will benefit surgical decision-making and lead to improved functional outcomes; and (2) integration of imaging, registration, segmentation, and feedback using heads-up display (HUD) visualization will enhance existing and enable novel surgical maneuvers. We have assembled a multidisciplinary team of engineers and clinicians to perform foundational ex vivo and in vivo imaging studies to (1) quantitatively assess the safety and utility of 4D iSECTR- based surgical feedback; and (2) develop novel technologies, feedback mechanisms, and maneuvers that integrate volumetric iSECTR data for image-guided ophthalmic surgery. Comprehensive 4D imaging of tissue- instrument interaction dynamics (AIM 1) provides unprecedent data on structural changes resulting from surgical manipulation that may be predictive of post-operative functional outcomes and enable image-based interrogation of biomechanics and personalized surgical planning. Real-time surgical visualization and guidance (AIM 2) may improve success rates of conventional surgical interventions as well as next-generation gene and stem cell therapies. Image-guided surgery also may be compatible with robotic-assistance and telemanipulation in wide- ranging surgical specialties outside of ophthalmology. Quantitative analysis of intraoperative imaging performance, utility, and clinical value (AIM 3) will motivate future technology development and clinical adoption.