Review of intraoperative optical coherence tomography: technology and applications [Invited]

Abstract

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.

Surgical removal of a giant iris stromal cyst: an intraoperative optical coherence tomography-guided approach

“…Large cyst occupying more than half of anterior chamber, cyst required extensive surgical manipulation during surgery and in cases of incomplete removal, chances of recurrence will be there 14 15. iOCT is being used for various anterior and posterior segment surgery like Descemet’s stripping automated endothelial keratoplasty, deep anterior lamellar keratoplasty, inner limiting membrane peeling during various retinal surgery and others 16. In this case, we separated the anterior cyst wall from the endothelium by viscodissection under the guidance of iOCT, which revealed the definite separation of the cyst wall from the endothelium.…”

Intraocular robotic interventional surgical system (IRISS): Semi‐automated OCT‐guided cataract removal

“…High‐frequency ultrasound biometry provides real‐time, high‐resolution images but requires a contact medium between the probe and the eye to reduce signal reflection. In contrast, OCT provides a noncontact, real‐time, high‐resolution imaging modality that can be integrated into surgical instruments and microscopes . Most importantly, it has been shown that intraocular tissues can be visualized in OCT scans in both anterior and posterior segments …”

Liver tissue classification of en face images by fractal dimension‐based support vector machine

“…Although CT and MRI both provide quantitative prediction with computer‐aided diagnosis based on morphological features, usually the resolution is on the order of millimeters and is low . Because of the raised volumetric real‐time imaging performance, the ultra‐high resolution and intra‐surgical OCT (optical coherence tomography) have been developed as a computer‐aided diagnosis tool in detecting the boundary of benign or cancerous desease .…”