Contrast-Enhanced Intraoperative Optical Coherence Tomography
Contrast-Enhanced Intraoperative Optical Coherence Tomography
Optical coherence tomography (OCT) has revolutionised clinical ophthalmology. The translation of OCT into the operating room is a natural next step given its high-resolution anatomic information. Contrast agents and enhancement have significantly improved the diagnostic capabilities of numerous imaging modalities (such as CT and MRI). The use of OCT contrast agents in ophthalmology has been generally lacking. In this report, we describe the novel application of triamcinolone as an OCT contrast agent for intraoperative OCT to improve visibility of tissue interfaces and planes (eg, posterior hyaloid insertion points). The application of this technology may have wide-ranging implications for enhanced image-guided surgery, intraoperative OCT and dynamic or functional applications of OCT technology.
Since the initial descriptions of optical coherence tomography (OCT), the ability to visualise anatomic features and pathology in the eye has improved tremendously. The advent of spectral domain-optical coherence tomography (SD-OCT) improved the resolution and visualisation, while decreasing acquisition time. Although the quality of in vivo imaging has improved, widespread development of contrast-enhanced OCT has been limited. We have previously described the ex vivo use of prednisolone, lipid-based artificial tears and triamcinolone for contrast-enhanced OCT in the anterior segment. In addition, we described perioperative contrast-enhanced OCT to provide functional assessment of corneal wound integrity in eyes undergoing cataract surgery.
The enhanced visualisation achieved with contrast agents facilitates improved identification of tissue layers and allows for a more dynamic or functional OCT. Intraoperative optical coherence tomography (iOCT) is an emerging field that uses the high-resolution cross-sectional information afforded by OCT to improve visualisation of surgical ophthalmic pathology. iOCT provides the surgeon with a rapid feedback on microarchitectural changes and reveals the underlying impact of surgical manoeuvres on ophthalmic tissues. Transparent and translucent tissues are visualised en face in real time during a surgical procedure with a standard operating microscope. Efforts at seamless integration of iOCT into surgical practice include microscope integration, software advances, dynamic motion imaging, enhanced visualisation and development of surgical instruments. Using contrast-enhanced iOCT may provide improved visualisation of tissue interfaces. In this report, we provide a novel description of contrast-enhanced iOCT using preservative-free triamcinolone (Triesence, Alcon, Fort Worth, Texas, USA) as a contrast agent for posterior segment surgery.
Abstract and Introduction
Abstract
Optical coherence tomography (OCT) has revolutionised clinical ophthalmology. The translation of OCT into the operating room is a natural next step given its high-resolution anatomic information. Contrast agents and enhancement have significantly improved the diagnostic capabilities of numerous imaging modalities (such as CT and MRI). The use of OCT contrast agents in ophthalmology has been generally lacking. In this report, we describe the novel application of triamcinolone as an OCT contrast agent for intraoperative OCT to improve visibility of tissue interfaces and planes (eg, posterior hyaloid insertion points). The application of this technology may have wide-ranging implications for enhanced image-guided surgery, intraoperative OCT and dynamic or functional applications of OCT technology.
Introduction
Since the initial descriptions of optical coherence tomography (OCT), the ability to visualise anatomic features and pathology in the eye has improved tremendously. The advent of spectral domain-optical coherence tomography (SD-OCT) improved the resolution and visualisation, while decreasing acquisition time. Although the quality of in vivo imaging has improved, widespread development of contrast-enhanced OCT has been limited. We have previously described the ex vivo use of prednisolone, lipid-based artificial tears and triamcinolone for contrast-enhanced OCT in the anterior segment. In addition, we described perioperative contrast-enhanced OCT to provide functional assessment of corneal wound integrity in eyes undergoing cataract surgery.
The enhanced visualisation achieved with contrast agents facilitates improved identification of tissue layers and allows for a more dynamic or functional OCT. Intraoperative optical coherence tomography (iOCT) is an emerging field that uses the high-resolution cross-sectional information afforded by OCT to improve visualisation of surgical ophthalmic pathology. iOCT provides the surgeon with a rapid feedback on microarchitectural changes and reveals the underlying impact of surgical manoeuvres on ophthalmic tissues. Transparent and translucent tissues are visualised en face in real time during a surgical procedure with a standard operating microscope. Efforts at seamless integration of iOCT into surgical practice include microscope integration, software advances, dynamic motion imaging, enhanced visualisation and development of surgical instruments. Using contrast-enhanced iOCT may provide improved visualisation of tissue interfaces. In this report, we provide a novel description of contrast-enhanced iOCT using preservative-free triamcinolone (Triesence, Alcon, Fort Worth, Texas, USA) as a contrast agent for posterior segment surgery.