Intraoperative OCT: Now and What’s to Come

This year marks the 25th anniversary of optical coherence tomography (OCT), and thanks to recent advances, the imaging technique continues to revolutionize vitreoretinal surgery. According to Cynthia A. Toth, MD, at Retina Subspecialty Day on Friday, there are now 2 commercially available microscope-integrated intraoperative OCT (MT-OCT) platforms that capture live 2-D B-scan images during active surgery, allowing physicians to see real-time instrument-tissue interactions in a heads-up display. These systems also allow the whole surgical team to see 3-D images displayed on an external screen during pauses in surgery.

However, Dr. Toth believes that this technology still falls short in several areas. Specifically, surgeons must deal with maintaining the desired field of view, working around instrument shadows, and limitations in image resolution and processing time.

On the horizon. However, new technological developments may overcome these challenges. For example, an ultrafast swept-source MI-OCT that projects live 3-D volume imaging to a heads-up display is now under development. This investigational system, described as a 4-D MI-OCT, enables stereoscopic viewing for repair of macular hole and diabetic tractional detachments, as well as other surgeries. It may someday replace the conventional microscope view.—Aliyah Kovner

Financial disclosures. Dr. Toth: Alcon Laboratories: P; Hemosonics: P; National Eye Institute: S; Research to Prevent Blindness: S; The Hartwell Foundation: S; The James Andrew Family Charitable Foundation: S; The Triangle Community Foundation: S.

Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.