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.