Four-dimensional microscope- integrated optical coherence tomography to enhance visualization in glaucoma surgeries

• Published in: Indian journal of ophthalmology Vol. 65; no. 1; pp. 57 - 59
• Main Authors: Pasricha, Neel Dave, Bhullar, Paramjit Kaur, Shieh, Christine, Viehland, Christian, Carrasco-Zevallos, Oscar Mijail, Keller, Brenton, Izatt, Joseph Adam, Toth, Cynthia Ann, Challa, Pratap, Kuo, Anthony Nanlin
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.01.2017; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Adult; Aged, 80 and over; Analysis; Anterior Chamber - diagnostic imaging; Brief Communications; Care and treatment; Glaucoma; Glaucoma - diagnosis; Glaucoma - physiopathology; Glaucoma - surgery; Health aspects; Humans; Imaging, Three-Dimensional; Intraocular Pressure; Intraoperative imaging; Male; optical coherence tomography; Surgery, Computer-Assisted - methods; swept-source; Tomography; Tomography, Optical Coherence - methods; trabeculectomy; Trabeculectomy - methods; tube shunt; India
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/ijo.IJO_412_16

We report the first use of swept-source microscope-integrated optical coherence tomography (SS-MIOCT) capable of live four-dimensional (4D) (three-dimensional across time) imaging intraoperatively to directly visualize tube shunt placement and trabeculectomy surgeries in two patients with severe open-angle glaucoma and elevated intraocular pressure (IOP) that was not adequately managed by medical intervention or prior surgery. We performed tube shunt placement and trabeculectomy surgery and used SS-MIOCT to visualize and record surgical steps that benefitted from the enhanced visualization. In the case of tube shunt placement, SS-MIOCT successfully visualized the scleral tunneling, tube shunt positioning in the anterior chamber, and tube shunt suturing. For the trabeculectomy, SS-MIOCT successfully visualized the scleral flap creation, sclerotomy, and iridectomy. Postoperatively, both patients did well, with IOPs decreasing to the target goal. We found the benefit of SS-MIOCT was greatest in surgical steps requiring depth-based assessments. This technology has the potential to improve clinical outcomes.