Abstract
Background In recent years, great progress has been made in intraoperative imaging using optical
coherence tomography (iOCT). There are now several commercially available iOCT systems
that allow high-resolution imaging of all structures of the eye without interrupting
surgery. This real-time visualisation can provide additional information to conventional
surgical microscopy, but is relatively expensive. The aim of our study was to find
out how often OCT integrated into the surgical microscope is used by trained surgeons,
or to what extent they consider that iOCT is relevant for intraoperative procedures.
Patients and Methods A prospective monocentric analysis was conducted of the field of application and
user-friendliness of the EnFocus Ultra-Deep OCT (Leica Microsystems), a mobile device
combination of surgical microscope and OCT. The use and benefit were investigated
of iOCT, which was not mandatory. Standardised documentation and evaluation using
a questionnaire was performed by the respective surgeon (n = 5) immediately after
surgery.
Results Over a period of 25 working days, 118 procedures were performed in the operating
theatre equipped with the microscope-OCT combination. The iOCT was used in 24.6% of
the 118 procedures performed. iOCT was regarded as crucial to the intraoperative procedure
in 3 of the 29 patients. In one patient, it was possible to check graft orientation
during a DMEK operation in a very opaque cornea and, in the second patient, to visualise
the correct positioning of an iris diaphragm in the capsular bag. In the third patient,
the risk of developing a pseudoforamen was assessed, and this led to the decision
not to perform a full gliosis peel.
Conclusion Experienced surgeons in a university eye hospital with a full surgical spectrum considered
that intraoperative OCT was decisive for the course of surgery in only a few selected
surgical situations, e.g. in case of limited corneal transparency. The impact of the
use of iOCT on post-operative outcome quality still needs to be evaluated by larger
prospective studies. On the basis of this survey, the cost-benefit ratio is still
unclear.
Key words
cataract - cornea - glaucoma - retina - iOCT
