Intraoperative imaging of macular hole repair to predict visual function outcomes

黄斑裂孔修复术中成像以预测视功能结果

• 批准号: 10225463
• 负责人: Yuankai Kenny Tao
• 金额: $ 34.78万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10225463
• 关键词: 4D Imaging; Adoption; Adult; Affect; American; Anatomy; Automobile Driving; Blindness; Clinical; Clinical Research; Clinical Treatment; Cornea; Data; Data Set; Development; Diagnostic; Dimensions; Disease; Engineering; Eye; FDA approved; Feedback; Foundations; Generations; Gold; Image; Image-Guided Surgery; Inner Limiting Membrane; Lead; Legal; Link; Macular Hole; Measures; Methods; Microscope; Microscopy; Motion; Operative Surgical Procedures; Ophthalmology; Optical Coherence Tomography; Outcome; Patients; Photoreceptors; Postoperative Period; Prevalence; Process; Progressive Disease; Recovery; Research; Resolution; Retina; Retinal Photoreceptors; Sampling; Severities; Speed; Structure; Surgical Management; Surgical Specialties; Surrogate Markers; System; Techniques; Technology; Testing; Thick; Time; Tissues; Traction; Translating; Trauma; United States; Vision; Visual Acuity; Visual Fields; Visual impairment; Visualization; Vitrectomy; aging population; archive data; base; biomarker identification; clinical Diagnosis; clinical decision-making; clinical diagnostics; cost; data acquisition; data archive; density; digital imaging; follow-up; functional outcomes; image guided; imaging biomarker; imaging study; in vivo; instrument; instrumentation; interest; multimodality; novel; outcome prediction; prognostic; programs; repaired; standard of care; tomography

Low vision and blindness affect over 40 million Americans and have an estimated annual cost of $25 billion for clinical diagnosis and treatment. The prevalence of visual impairment in adults 40 years and older in the United States is above 3.5% and expected to increase markedly due to population aging. Many ocular diseases are progressive and require surgical management at advanced stages, which involves precision manipulation of delicate semi-transparent structures in the eye. Optical coherence tomography (OCT) has revolutionized ophthalmic imaging by allowing for high-resolution noninvasive visualization of retinal microstructure and has become the “gold standard” for clinical diagnostics. However, despite broad adoption of preoperative OCT for surgical planning and predicting outcomes, postoperative functional outcomes may be highly variable. In macular hole (MH) surgery, ~90% of patients achieve hole closure and anatomic normalization but as low as 27% of patients achieve a best-corrected visual acuity of >20/40 (legal driving limit). We hypothesize that (1) structural changes in the retina during MH repair, which are prognostic of postoperative visual function, result directly from surgical intervention; (2) iOCT imaging of MH dynamics during surgery will enable quantification of image-based biomarkers and identification of corresponding tissue-instrument interactions that lead to poor functional outcomes; and (3) understanding the causal relationship between surgical manipulation and postoperative vision will benefit clinical decision-making and novel surgical technique and intraoperative feedback mechanism development for MH repair and other ocular diseases. Our collaborative program of engineers and clinicians will perform foundational imaging studies to understand the casual effects that surgical maneuvers have on postoperative vision recovery during MH repair. To overcome limitations of current-generation iOCT systems, we have developed multimodal spectrally encoded coherence tomography and reflectometry (SECTR) technologies that allows for simultaneous and intrinsically co-registered en face reflectance and cross-sectional OCT imaging. SECTR uses concurrently acquired spectrally encoded reflectance (SER) en face and OCT cross- sectional images to provide complementary spatial information in orthogonal dimensions and enable volumetric registration and tracking. Segmentation of motion-corrected 4D OCT datasets in post-processing has enabled retinal layer identification and quantification of tissue deformations resulting from surgical manipulation. Automated tracking and 4D imaging of MH dynamics (AIM 1) provides unprecedent data on structural changes resulting from surgical manipulation that have been shown to be predictive of postoperative functional outcomes (AIM 2). In vivo iSECTR imaging during MH repair will be performed to understand the causal relationship between surgical dynamics and postoperative visual function (AIM 3) and may lead to novel image-guided surgical maneuvers. Technologies developed during this project will have broad applications in personalized surgery, predicting outcomes, and image-guided feedback in a wide-range of surgical specialties.

低视力和失明会影响超过4000万美国人，估计每年250亿美元的成本 临床诊断和治疗。曼联40岁以上的成年人视力障碍的患病率 国家高于3.5％，预计由于人口衰老而明显增加。许多眼部疾病是 进步，需要在高级阶段进行手术管理，这涉及到精确操纵 眼睛中精致的半透明结构。光学相干断层扫描（OCT）已革新 通过允许高分辨率的视网膜微观结构可视化来进行眼科成像，并具有 成为临床诊断的“黄金标准”。但是，dospite广泛采用了术前的OCT 手术计划和预测结果，术后功能结果可能是高度可变的。在黄斑中 孔（MH）手术，约90％的患者达到孔闭合和解剖归一化，但低至27％ 患者的视力最高> 20/40（法定驾驶极限）。我们假设（1）结构 MH修复期间视网膜的变化是术后视觉功能的预后，直接由 手术干预； （2）手术过程中MH动力学的IOCT成像将实现基于图像的基于图像的量化 生物标志物和相应的组织启动相互作用的鉴定，导致功能不佳 结果； （3）了解手术操纵与术后视力之间的因果关系 将有益于临床决策和新型手术技术和术中反馈机制 MH修复和其他眼部疾病的开发。我们的工程师和临床医生协作计划将 进行基本的成像研究以了解外科手术对的随意影响 MH修复期间的术后视力恢复。为了克服当前产生IOCT系统的局限性， 我们已经开发了多模式编码的相干断层扫描和反射法（SECTR） 允许简单且内在共同注射的脸部反射率和横截面的技术 OCT成像。 Sectr使用同时获得的光谱编码反射率（Ser）en face和Oct cross- 截面图像以在正交维度中提供完整的空间信息并启用体积 注册和跟踪。启用了后处理中运动校正的4D OCT数据集的分割 手术操纵引起的组织变形的视网膜层鉴定和定量。 MH动力学的自动跟踪和4D成像（AIM 1）提供了有关结构变化的前所未有的数据 由于手术操作而导致的，这些操作已被证明是术后功能结果的预测 （目标2）。 MH修复期间将进行体内ISECTR成像以了解因果关系 在手术动力学和术后视觉功能（AIM 3）之间，可能导致新的图像引导 外科手术。该项目期间开发的技术将在个性化中广泛应用 在广泛的手术专业中，手术，预测结果和图像引导的反馈。