Intraocular OCT Real-time Monitoring of Laser Retinectomy

描述(申请人提供)：眼科研究人员开创的激光手术和眼部相干断层扫描对目前诊断、理解、治疗和监测多种眼部疾病的能力产生了巨大的全球健康影响。将这两种强大的模式组合成一个微型的眼内探头以监测和指导实时激光手术的潜力尚未开发。随着提高外科医生技术精确度的新设备的出现，手术结果将会取得进步。该项目提出，可以开发一种带有微型探头的系统，实时监控组织层的切割，以保护底层组织免受伤害。为了实现精确的图像引导切割，定制的实时光谱域光学相干层析成像(SDOCT)成像系统将与新型桌面6.1&lt；m中红外(IR)切割激光相结合，通过微型20规格原型探头进行输送。这项技术将被开发并应用于视网膜切除术。切开邻近前部增生性玻璃体视网膜病变的视网膜以实现视网膜再附着在技术上是具有挑战性的。随着未控制的糖尿病在人群中的流行以及简易爆炸装置造成的严重眼外伤的出现，这项技术正越来越频繁地被使用。原型的初步评估将在人工分离的猪视网膜上进行。成像和激光光斑将在目标组织上重叠，以允许在切割进行到视网膜下空间时对组织层消融进行实时成像。当发生这种情况时，探头将被移动到邻近位置，以允许继续切割视网膜，同时防止对底层视网膜色素上皮的损害。所有的切口都将接受组织学检查，以评估热损伤，检查潜在的组织结构，并与SDOCT信号谱进行比较，以指导改进探头以实现最佳性能。提案完成后，手持式SDOCT成像/红外激光/透热探头和系统将准备好在动物实验中进行验证。假设：可以开发一种带有微型探头的系统来监控组织层的实时切割，以保护下面的组织免受伤害。目的一、研制一种红外激光波导探头和一种新型的SDOCT成像探头，并将其组合成符合人体工程学的20号探头，用于眼内手术。目的II.优化和验证SDOCT系统用于评估通过20号探头进行的人工视网膜激光切割术(视网膜切除术)的可行性。与公共卫生相关：目标是通过将光成像技术与微型探头中的切割激光相结合来实现安全的图像引导切割。当组织层发生切割时，成像将被用来检测它，以保护下面的结构免受伤害。这一概念将在视网膜眼内手术中探索，但在多个外科领域具有深远的相关性。

DESCRIPTION (provided by applicant): The pioneering of laser surgery and ocular coherence tomography by eye researchers has had a tremendous global health impact upon the current ability to diagnose, understand, treat, and monitor multiple eye diseases. The potential of combining these two powerful modalities into a miniature intraocular probe to monitor and guide real-time laser surgery is untapped. Advances in surgical outcomes will occur with new devices to increase the technical precision of surgeons. This project proposes that a system with a miniature probe can be developed that monitors real-time incision of a tissue layer to protect the underlying tissues from injury. To achieve precise image-guided incisions, a customized real-time spectral domain optical coherence tomography (SDOCT) imaging system will be combined with a novel table-top 6.1 <m mid-infrared (IR) incising laser for delivery through miniature 20-gauge prototype probes. This technology will be developed and applied to retinectomy. Incising retina adjacent to anteriorly located proliferative vitreoretinopathy to achieve retinal re- attachment is technically challenging. This technique is being more frequently employed with the increasing prevalence of uncontrolled diabetes in the population and the advent of severe ocular trauma from improvised explosive devices. Initial evaluation of the prototypes will occur on artificially detached porcine retinas. The imaging and lasing spots will overlap on the target tissue to permit real-time imaging of tissue layer ablation as the incision proceeds to the subretinal space. As this occurs, the probe will be moved to an adjacent location to permit continued incision of the retina while preventing damage to underlying retinal pigment epithelium. All incisions will be examined histologically to evaluate for thermal injury, to inspect underlying tissue structures, and to compare to the SDOCT signal profile in order to guide modification of the probes for optimal performance. Upon proposal completion, a hand-held combined SDOCT imaging/ IR laser/ diathermy probe and system will be ready to verify in an animal study. Hypothesis: A system with a miniature probe can be developed that monitors real-time incision of a tissue layer to protect the underlying tissues from injury. Aim I. An IR laser waveguide probe and a novel SDOCT imaging probe will be developed and then combined into an ergonomic 20-gauge probe for intraocular surgery. Aim II. Optimize and demonstrate feasibility of the SDOCT system to evaluate real-time laser incising of artificially detached retinas (retinectomy procedure) delivered through the 20-gauge probe. PUBLIC HEALTH RELEVANCE: The goal is to achieve safe image-guided incisions by combining light-imaging technology with an incising laser in a miniature probe. The imaging will be exploited to detect incision of a tissue layer as it occurs to protect the underlying structures from injury. This concept will be explored in a retinal intraocular procedure, but has profound relevance for multiple surgical areas.