Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery with intraoperative optical coherence tomography.
Abstract
Minimally-invasive microsurgery has resulted in improved outcomes for patients. However,
operating through a microscope limits depth perception and fixes the visual perspective,
which result in a steep learning curve to achieve microsurgical proficiency. We introduce
a surgical imaging system employing four-dimensional (live volumetric imaging through
time) microscope-integrated optical coherence tomography (4D MIOCT) capable of imaging
at up to 10 volumes per second to visualize human microsurgery. A custom stereoscopic
heads-up display provides real-time interactive volumetric feedback to the surgeon.
We report that 4D MIOCT enhanced suturing accuracy and control of instrument positioning
in mock surgical trials involving 17 ophthalmic surgeons. Additionally, 4D MIOCT imaging
was performed in 48 human eye surgeries and was demonstrated to successfully visualize
the pathology of interest in concordance with preoperative diagnosis in 93% of retinal
surgeries and the surgical site of interest in 100% of anterior segment surgeries.
In vivo 4D MIOCT imaging revealed sub-surface pathologic structures and instrument-induced
lesions that were invisible through the operating microscope during standard surgical
maneuvers. In select cases, 4D MIOCT guidance was necessary to resolve such lesions
and prevent post-operative complications. Our novel surgical visualization platform
achieves surgeon-interactive 4D visualization of live surgery which could expand the
surgeon's capabilities.
Type
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https://hdl.handle.net/10161/12788Published Version (Please cite this version)
10.1038/srep31689Publication Info
Carrasco-Zevallos, OM; Keller, B; Viehland, C; Shen, L; Waterman, G; Todorich, B;
... Izatt, JA (2016). Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery
with intraoperative optical coherence tomography. Sci Rep, 6. pp. 31689. 10.1038/srep31689. Retrieved from https://hdl.handle.net/10161/12788.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Oscar Carrasco-Zevallos
Student
I am a senior graduate student in the Biophotonics Group at Duke. My research focuses
on the development of optical imaging technologies for various biomedical applications.
My current projects include intraoperative optical coherence tomography (OCT) to guide
ocular surgery, eye-tracking for motion-compensated OCT ophthalmic imaging, and novel
OCT designs for pediatric imaging. I am currently searching for post-doc opportunities
and hope to become a professor in the field of biophotonics in the
Sina Farsiu
Professor in the Department of Biomedical Engineering
I am the director of the Vision and Image Processing (VIP) Laboratory. Along with
my colleagues, we investigate how to improve early diagnostic methods and find new
imaging biomarkers of ocular and neurological diseases in adults (e.g. age-related
macular degeneration, diabetic retinopathy, Glaucoma, Alzheimer) and children (e.g.
retinopathy or prematurity). We also develop automatic artificial intelligence machine
learning and deep learning algorithms to detect/segment/quantify anatomical/patho
Paul Hahn
Assistant Professor of Ophthalmology
I have been extensively involved in research throughout my academic career. While
an undergraduate at Harvard College, I studied various proteins at an ultrastructural
level towards rational design of novel drugs. During medical school at the University
of Pennsylvania, I continued with basic science research studying mechanisms of action
of nuclear receptors and optimizing protocols for gene therapy. I completed my PhD
at the University of Pennsylvania studying the role of iron overload
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Joseph A. Izatt
Michael J. Fitzpatrick Distinguished Professor of Engineering in the Edmund T. Pratt,
Jr. School of Engineering
My research centers on the development and application of cutting-edge optical technologies
for non-invasive, high-resolution imaging and sensing in living biological tissues.
Our laboratory is recognized for foundational contributions to optical coherence-based
approaches for in vivo sub-surface microscopic tissue imaging, particularly optical
coherence tomography (OCT) which has become a standard of care in ophthalmology and
other clinical specialties. The technologies we employ includ
Brenton Keller
Affiliate
Anthony Nanlin Kuo
Associate Professor of Ophthalmology
Cynthia Ann Toth
Joseph A.C. Wadsworth Distinguished Professor of Ophthalmology
RESEARCH INTERESTS Dr. Toth specializes in the evaluation and surgical treatment
of vitreoretinal diseases in infants, children and adults, and in novel research resulting
in the clinical application of optical coherence tomography (OCT) imaging in surgery
and at the bedside. Her clinical interests and skills include the surgical treatment
of macular diseases (such as, macular hole, epiretinal membrane and vitreomacular
traction), retinal detachment, proliferative diabetic ret
Christian Viehland
Research Scientist
Gar Waterman
Associate In Research
I am a design/R&D engineer specializing in the multi-disciplinary and application-specific
design of devices and instrumentation for medical and life sciences fields. My academic
background and experiences have been in biomedical engineering and optomechanics.
I have been employed primarily in the research sector and have had exposure to both
industry and business.
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