Enhancement of Microscope-Integrated Optical Coherence Tomography (MIOCT) Guidance in Ophthalmic Surgery

Abstract

4D-microscope-integrated optical coherence tomography (4D-MIOCT) is a multimodal imaging technology consisting of live volumetric OCT (4D-OCT) implemented in tandem with standard stereo color microscopy for the purpose of microsurgical visual guidance. 4D-OCT enhances the surgeon’s microscopy view with many useful real time 3D visual cues not available in standard microscopy in a variety of clinical procedures; however there remain scenarios under which it is not feasible to leverage the benefits of this 3D imaging modality. It is the objective here to investigate the nature of these scenarios and develop solutions aimed at improving the utility of OCT guidance under such conditions.This is a large and complex problem; for the scope of this work, we select three high-impact scenarios in particular: first, the challenges encountered by the surgeon when attempting to effectively integrate cues in real-time from simultaneous-but-separate imaging channels (standard digital color stereomicroscopy, and 4D-MIOCT). Second, the limited penetration depth of optical coherence tomography (OCT) imaging due to tissue scattering, specifically in transscleral operations, where embedded targets including anatomical features, lesions, and malignancies are obscured from OCT by highly scattering scleral tissue. Third, a clinic-ready 4D-MIOCT system is needed to create a platform for the application of these technologies in the OR, requiring substantial translational research. The works addressing these three issues constitute the three aims of the research work, each to be detailed in a chapter of this dissertation. The first utilizes a digital approach applying image processing and segmentation in order to enhance the visual interface between a digital image feed display and the surgeon. The second is a chemical technique leveraging new applications of absorbing agents in optical clearing for enhancing biological tissue imaging. Here, it is applied to increase the imaging depth of optical coherence tomography in scattering ophthalmic tissues like the sclera. Finally, we will describe our process of creating a foundation for the translation of these MIOCT-borne technologies into a clinical operating room setting.