Stellenwert der intraoperativen optischen Kohärenztomografie in der Netzhautchirurgie. Teil 2: contra

Zusammenfassung

Eine der kontroversesten Diskussionen in der Netzhautchirurgie wird derzeit über den Stellenwert der intraoperativen optischen Kohärenztomografie (iOCT) geführt. Hintergrund ist der Wunsch, den 2-dimensionalen Fundusblick des Operateurs mit der geschichteten Tiefeninformation der OCT zu kombinieren, um eine Art 4-dimensionale „Augmented Reality“ (3-D plus Veränderung über die Zeit) zu erreichen. Dies soll feine Strukturen, die dem Blick des Operateurs bisher verborgen sind, sichtbar machen. Deshalb erscheint die Netzhautchirurgie prädestiniert für den Einsatz einer iOCT zu sein. Die große Hoffnung liegt darin, dass ein dynamisches Live-3-D-Bild mit Echtzeit-Feedback dem Operateur zusätzliche Informationen liefert und die Sicherheit verbessert. So faszinierend die iOCT-Technologie auf den ersten Blick ist, so enttäuscht sie doch im klinischen Alltag, gerade in der Makulachirurgie. Sie liefert nur selten Informationen, die ohne iOCT nicht erzielbar wären oder durch präoperative Diagnostik nicht in wesentlich besserer Qualität vorlägen. Hoffnungsvoll sind einige Sonderindikationen, die insbesondere die subretinale Chirurgie betreffen.

Abstract

One of the most controversial discussions in retinal surgery is currently being held about the importance of intraoperative OCT (iOCT). The background is the desire to combine the 2-dimensional fundus view of the surgeon with the layered depth information of OCT to achieve a 4-dimensional “augmented reality” (3-D plus change over time). This should help to visualise fine structures, which have been hidden from the surgeonʼs view. Therefore, retinal surgery seems to be predestined for the use of iOCT. The great hope is that a dynamic live 3-D image with real-time feedback will provide the surgeon with additional information and improve safety. Although fascinating at the first glance, in the surgical routine, however, iOCT technology is disappointing, especially in macular surgery. It rarely provides substantial information that would not be obtainable without iOCT or that would not be available in much better quality through preoperative diagnostic testing. Only some special indications remain, particularly related to subretinal surgery.

Schlüsselwörter

Retina - Spectral-Domain optische Echtzeit-Kohärenztomografie - intraoperative OCT - Makulachirurgie - digitale Mikroskopie

Key words

spectral domain real-time optical coherence tomography - intraoperative OCT - macular surgery - digital microscopy

Publication History

Received: 30 January 2020

Accepted: 09 March 2020

Article published online:
15 October 2020

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