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iStent insertion orientation and impact on trabecular meshwork motion resolved by optical coherence tomography

Zhaoyu Gong1, Murray A Johnstone2, Ruikang K Wang1,2

  • 1University of Washington, Department of Bioengineering, Seattle, Washington, United States.

Journal of Biomedical Optics
|July 29, 2024
PubMed
Summary

Optical coherence tomography (OCT) offers new ways to assess iStent glaucoma surgery. This imaging reveals iStent placement variations and biomechanical changes in the eye's fluid drainage system.

Keywords:
glaucomaiStentmicroinvasive glaucoma surgeryphase-sensitive optical coherence tomographytrabecular meshwork

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Area of Science:

  • Ophthalmology
  • Biomedical Engineering
  • Medical Imaging

Background:

  • The iStent is a key device for glaucoma treatment, creating a pathway for aqueous humor drainage.
  • Accurate assessment of iStent implantation is crucial for patient outcomes.
  • Current assessment methods for iStent surgery provide limited information.

Purpose of the Study:

  • To develop novel assessment strategies for iStent implantation using optical coherence tomography (OCT).
  • To evaluate the precise position and orientation of implanted iStents.
  • To measure the biomechanical impact of iStents on the eye's fluid outflow system.

Main Methods:

  • Utilized three-dimensional (3D) OCT structural imaging to visualize iStents in a glaucoma patient.
  • Developed a semi-automated algorithm for iStent segmentation and measurement of position and orientation.
  • Employed phase-sensitive OCT (PhS-OCT) to quantify biomechanical effects via cumulative displacement (CDisp) of trabecular meshwork motion.

Main Results:

  • 3D OCT imaging precisely determined iStent position and orientation, showing significant variability.
  • PhS-OCT revealed substantially increased CDisp in areas between iStents compared to distant regions.
  • The imaging successfully characterized iStent placement and biomechanical alterations.

Conclusions:

  • The proposed OCT-based structural imaging enhances characterization of iStent placement.
  • Findings indicate challenges in achieving precise iStent insertion control.
  • PhS-OCT imaging highlights potential biomechanical alterations caused by iStents, suggesting its clinical utility.