Integrative Advances for OCT-Guided Ophthalmic Surgery and Intraoperative OCT: Microscope Integration, Surgical Instrumentation, and Heads-Up Display Surgeon Feedback

<div><p>Purpose</p><p>To demonstrate key integrative advances in microscope-integrated intraoperative optical coherence tomography (<i>i</i>OCT) technology that will facilitate adoption and utilization during ophthalmic surgery.</p><p>Methods</p><p>We developed a second-generation prototype microscope-integrated <i>i</i>OCT system that interfaces directly with a standard ophthalmic surgical microscope. Novel features for improved design and functionality included improved profile and ergonomics, as well as a tunable lens system for optimized image quality and heads-up display (HUD) system for surgeon feedback. Novel material testing was performed for potential suitability for OCT-compatible instrumentation based on light scattering and transmission characteristics. Prototype surgical instruments were developed based on material testing and tested using the microscope-integrated <i>i</i>OCT system. Several surgical maneuvers were performed and imaged, and surgical motion visualization was evaluated with a unique scanning and image processing protocol.</p><p>Results</p><p>High-resolution images were successfully obtained with the microscope-integrated <i>i</i>OCT system with HUD feedback. Six semi-transparent materials were characterized to determine their attenuation coefficients and scatter density with an 830 nm OCT light source. Based on these optical properties, polycarbonate was selected as a material substrate for prototype instrument construction. A surgical pick, retinal forceps, and corneal needle were constructed with semi-transparent materials. Excellent visualization of both the underlying tissues and surgical instrument were achieved on OCT cross-section. Using model eyes, various surgical maneuvers were visualized, including membrane peeling, vessel manipulation, cannulation of the subretinal space, subretinal intraocular foreign body removal, and corneal penetration.</p><p>Conclusions</p><p>Significant iterative improvements in integrative technology related to <i>i</i>OCT and ophthalmic surgery are demonstrated.</p>