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Intraoperative OCT - Real-World User Evaluation in Routine Surgery.

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Intraoperative optical coherence tomography (iOCT) integrated into surgical microscopes is used infrequently by experienced surgeons. While beneficial in select cases like poor corneal transparency, its overall impact and cost-effectiveness require further study.

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Surgical Technology

Background:

  • Intraoperative optical coherence tomography (iOCT) offers high-resolution, real-time imaging during eye surgery without interrupting procedures.
  • While iOCT provides valuable supplementary information to surgical microscopy, its high cost is a consideration.
  • The adoption and perceived relevance of iOCT by experienced surgeons in daily practice remain to be fully understood.

Purpose of the Study:

  • To evaluate the frequency of use of integrated iOCT by trained surgeons.
  • To assess the perceived relevance and impact of iOCT on intraoperative decision-making.
  • To investigate the user-friendliness and application scope of a specific iOCT system (EnFocus Ultra-Deep OCT).

Main Methods:

  • A prospective, monocentric study involving 5 experienced surgeons.
  • Analysis of 118 consecutive surgical procedures over 25 working days using a microscope-OCT combination.
  • Standardized documentation and post-operative questionnaires to record iOCT usage and perceived benefit.

Main Results:

  • iOCT was utilized in 24.6% of the 118 procedures.
  • iOCT was deemed crucial in only 3 cases, including DMEK with opaque cornea, iris diaphragm positioning, and pseudoforamen risk assessment.
  • Specific benefits included graft orientation checks and visualization of device placement.

Conclusions:

  • Experienced surgeons in a comprehensive eye hospital found iOCT decisive only in specific situations, such as limited corneal transparency.
  • The impact of iOCT on post-operative outcomes requires further investigation through larger prospective studies.
  • The cost-benefit ratio of integrated iOCT remains unclear based on this survey.