During microsurgery, en face imaging of the surgical field through the operating microscope limits the surgeon's depth perception and visualization of instruments and subsurface anatomy. Surgical procedures outside microsurgery, such as breast tumor resections, may also benefit from visualization of the sub-surface tissue structures. The widespread clinical adoption of optical coherence tomography (OCT) in ophthalmology and its growing prominence in other fields, such as cancer imaging, has motivated the development of intraoperative OCT for real-time tomographic visualization of surgical interventions. This article reviews key technological developments in intraoperative OCT and their applications in human surgery. We focus on handheld OCT probes, microscope-integrated OCT systems, and OCT-guided laser treatment platforms designed for intraoperative use. Moreover, we discuss intraoperative OCT adjuncts and processing techniques currently under development to optimize the surgical feedback derivable from OCT data. Lastly, we survey salient clinical studies of intraoperative OCT for human surgery.
Ophthalmic procedures demand precise surgical instrument control in depth, yet standard operating microscopes supply limited depth perception. Current commercial microscope-integrated optical coherence tomography partially meets this need with manually-positioned cross-sectional images that offer qualitative estimates of depth. In this work, we present methods for automatic quantitative depth measurement using real-time, two-surface corneal segmentation and needle tracking in OCT volumes. We then demonstrate these methods for guidance of ex vivo deep anterior lamellar keratoplasty (DALK) needle insertions. Surgeons using the output of these methods improved their ability to reach a target depth, and decreased their incidence of corneal perforations, both with statistical significance. We believe these methods could increase the success rate of DALK and thereby improve patient outcomes.
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