Real-Time Volumetric Imaging of Vitreoretinal Surgery with a Prototype Microscope-Integrated Swept-Source OCT Device.

PURPOSE To evaluate the images produced in an initial surgical series of intraoperative near-real-time volumetric swept-source (SS) OCT imaging. DESIGN Prospective translational study. PARTICIPANTS Forty-one consecutive adult patients undergoing vitreoretinal surgery between July 22, 2014, and July 1, 2015, at the Duke University Eye Center who agreed to participate. METHODS A novel microscope-integrated SS-OCT prototype captured volumetric renderings of imaging of macular surgery in near-real-time and showed them to the surgeon via a heads-up display through the microscope oculars. Then the images were analyzed formally after surgery. MAIN OUTCOME MEASURES Image quality, successful capture of surgical instruments, maneuvers and associated retinal deformation volumetrically over time, and qualitative image analysis. RESULTS Volumetric SS-OCT images were graded as acceptable in 92% of patients. Volumetric imaging of scraping and peeling procedures was achieved in 75% and 78% of patients in whom it was performed, respectively. Imaging provided the surgeon with near-real-time volumetric visualization of the position of the instrument relative to the retinal surface, flap initiation, flap removal, and retinal deformation during instrumentation via a heads-up display. CONCLUSIONS This volumetric, microscope-integrated SS-OCT prototype seems to provide high-detail, near-real-time volumetric imaging of delicate maneuvers during macular surgery.