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Klin Monbl Augenheilkd 2018; 235(07): 820-829
DOI: 10.1055/s-0042-122710
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Intraoperative optische Kohärenztomografie – eine aktuelle Übersicht klinischer Studien zur Anwendung im Vorder- und Hinterabschnitt

Intraoperative Optical Coherence Tomography – an Overview of Current Clinical Data for the Application in the Anterior and Posterior Segments
A. J. Augustin
Augenklinik, Klinikum Karlsruhe
› Institutsangaben
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Publikationsverlauf

eingereicht 10. November 2016

akzeptiert 21. November 2016

Publikationsdatum:
10. Februar 2017 (online)

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Zusammenfassung

Die intraoperative optische Kohärenztomografie (iOCT) stellt einen weiteren, erheblichen Entwicklungsschritt in der ophthalmologischen Bildgebung dar – erstmals sind nun hochaufgelöste OCT-Darstellungen nicht nur prä- und postoperativ, sondern auch intraoperativ verfügbar. In den letzten Jahren wurden intraoperative OCT-Technologien intensiv erforscht und von ersten, handgehaltenen, über auf das Mikroskop aufmontierten Systemen bis hin zu vollständig in das Operationsmikroskop integrierten Systemen weiterentwickelt. Diese liefern uns während eines chirurgischen Eingriffs bei quasi unverändertem Arbeitsumfeld in Echtzeit 3-dimensionale OCT-Bilder und bieten uns so zusätzlich zur Mikroskopansicht weitere Informationen, wie z. B. zu Mikrostrukturen der Netzhaut oder der Kornea, die die Operationsstrategie bei Vorder- und Hinterabschnittseingriffen beeinflussen können. Wie jede neue Technologie weist auch die iOCT derzeit noch einige Limitationen auf, wie z. B. durch die Instrumente hervorgerufene Abschattungen des darunterliegenden Gewebes oder fehlende Tracking-Systeme. Daher ist zum derzeitigen Stand der Technologie noch etwas Geschick erforderlich, um chirurgische Manöver mit der iOCT in Echtzeit nachzuverfolgen. Dies wird durch zukünftige Weiterentwicklungen sicherlich behoben werden. Auch wenn die iOCT nicht für alle Prozeduren erforderlich ist, so kann es doch bei vielen chirurgischen Eingriffen am Vorder- bzw. Hinterabschnitt schon heute zu mehr Sicherheit und Kontrolle beitragen, wie zahlreiche Studien und Fallserien zeigen. Insbesondere bei der Entfernung vitreomakulärer Traktionen oder epiretinaler Membranen (ERM-Peeling) wie auch bei der Operation von Makulaforamina bietet die iOCT den Chirurgen eine deutliche Unterstützung, indem sie zur besseren Visualisierung transparenter Strukturen beiträgt, eine direkte Erfolgskontrolle ermöglicht und in bestimmten Fällen den Einsatz von Farbstoffen überflüssig macht. Auch bei lamellären hornhautchirurgischen Eingriffen sowie in der Glaukomchirurgie kann die iOCT zu mehr Kontrolle und Präzision beitragen. Zudem können mithilfe der iOCT neue wissenschaftliche Erkenntnisse zu verschiedenen Pathologien gewonnen, Auswirkungen chirurgischer Manöver auf die okuläre Strukturen besser evaluiert und somit chirurgische Manöver langfristig optimiert werden. Zur besseren Beurteilung des Nutzens der iOCT für verschiedene chirurgische Prozeduren werden zukünftig weitere prospektive Studien erforderlich sein.

Abstract

Intraoperative optical coherence tomography (iOCT) represents another milestone in ocular imaging technologies. Now, for the first time, high resolution OCT images are available not only pre- or postoperatively, but also intraoperatively. In recent years, there have been significant advances in iOCT technology – from hand-held probes and mounted systems towards iOCT systems which are fully integrated into the surgical microscope and which provide seamless integration into the workflow. These systems offer high-resolution, intraoperative OCT scans in real-time and provide additional information on microstructures of the retina or the cornea. These findings may even lead to a modification of surgical strategies. Like any other new technology, iOCT technology still has some limitations, such as shadowing from instruments and the lack of eye tracking systems. Therefore, the current state of iOCT technology still requires some skill to track surgical maneuvers in real time. Further research and development will help to solve these limitations in the future. However, even if not required for all surgical procedures, iOCT imaging can already improve safety and control in many surgical procedures on the anterior and posterior segments. This has already been shown in several studies and case series. Particularly in the surgery of vitreomacular traction, peeling of epiretinal membranes (ERM peeling) and macular hole surgery, iOCT offers significant added value. It improves the visualisation of transparent structures and helps to avoid the usage of dyes. In addition the success of the surgical maneuvers can be investigated intraoperatively. In lamellar keratoplasty and glaucoma surgery too, iOCT improves precision and safety. Moreover, iOCT technology may help to achieve further insight into ocular pathologies and a better understanding of the impact of surgical maneuvers on visual rehabilitation. Further prospective studies are however required to evaluate the usefulness of iOCT in various surgical procedures on both, the anterior and posterior segments.

Schlüsselwörter

intraoperative optische Kohärenztomografie - Retina - Glaukom - Hornhauttransplantation - Bildgebung

Key words

intraoperative optical coherence tomography - corneal transplantation - imaging - retina - glaucoma
 

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