Optical coherence tomography (OCT) has traditionally been used in the outpatient environment as an important diagnostic tool for retinal clinical decision making. Recent advances in OCT technology have made intraoperative use of OCT feasible.
Dr. Puliafito receives a royalty payment from Massachusetts Eye and Ear Infirmary as a co-inventor of OCT and is a consultant to Carl Zeiss Meditec, Inc.
Since its first description in 1991,1 optical coherence tomography (OCT) has dramatically altered the outpatient evaluation of patients with macular disease. OCT is much more than a descriptive imaging technology. The advent of anti-vascular endothelial growth factor retinal pharmacotherapy rapidly elevated OCT to a position as the most commonly employed clinical decision-making tool in the retinal clinic. From the beginning, ophthalmic OCT has had an important role in preoperative and postoperative assessment of the vitreoretinal surgical patient. Specifically, OCT is extraordinarily valuable in assessing disorders of the vitreoretinal interface (ie, macular holes and simulating lesions, epiretinal membranes, and traction detachments of the macula).
The vast majority of clinical applications of OCT have studied the eye using a slit lamp or fundus camera-like strategy. The patient is imaged while sitting upright in front of the device. Some commercial systems have taken advantage of the fact that OCT systems are fiberoptically based and have used an OCT probe placed directly on the cornea.
Wykoff et al.2 used such a system to demonstrate the potential use of OCT for intraoperative decision making. Their intraoperative OCT images demonstrate dramatically the successful closure of a traumatic macular hole.
Other intraoperative OCT approaches include the use of an OCT endoprobe or use of transpupillary OCT mounted directly on the operating microscope. The high speed and large data sets of spectral-domain OCT (SD-OCT) have made such intraoperative imaging feasible.
- Huang D, Swanson EA, Lin CP, et al. Optical coherence tomography. Science. 1991;254:1178–1181. doi:10.1126/science.1957169 [CrossRef]
- Wykoff CC, Berrocal AM, Schefler AC, Uhlhorn SR, Ruggeri M, Hess D. Intraoperative OCT of a full-thickness macular hole before and after internal limiting membrane peeling. Ophthalmic Surg Lasers Imaging. 2010;41:7–11.