Microscope Integrated Intraoperative Spectral Domain Optical Coherence Tomography for Cataract Surgery: Uses and Applications
Purpose
To find the various applications, some novel, of a Microscope integrated intra operative Spectral Domain Optical Coherence Tomography (SD-OCT) to improve safety in cataract surgery.
Methods
Thirty-eight eyes of 38 patients underwent either manual micro-coaxial cataract surgery (MICS) or Femtosecond laser assisted cataract surgeries (FLACS) with a Microscope integrated with intra operative SD-OCT. The study was non-randomized and sequential with patients being assigned to either group based on their choice. Continuous SD-OCT video imaging was done during all the steps of the cataract surgery and additional high resolution still images were taken at crucial steps such as immediately after entry into the anterior chamber, following anterior capsule rhexis, during trenching, following implantation of the intraocular lens, and immediately after hydration of the clear corneal wounds.
Results
Twenty-six eyes underwent Manual MICS and 12 eyes underwent FLACS. The quality and multi-planar construction of the wounds, the margin of the anterior capsule rhexis, the end point for stromal hydration for adequate wound closure, evaluation of adequate depth during trenching to aid in cracking the nucleus, as well as lack of apposition of posterior surface of intraocular lenses made of various materials with the posterior capsule were clearly visualized. Both MICS as well FLACS wounds were comparable in geometry with similar quantity of hydration being required for adequate wound closure. Hydrophobic IOLs did not demonstrate any bio-adhesiveness intraoperatively.
Conclusion
Intraoprerative SD OCT integrated with the operating microscope is an interesting new
technology which would help us in real time in-vivo assessment of cataract surgery thereby helping us to optimize our outcomes. Additionally it also has a tremendous use as a research and teaching tool.