Intraoperative Optical Coherence Tomography for Ophthalmic Surgical Guidance

用于眼科手术指导的术中光学相干断层扫描

• 批准号: 9803346
• 负责人: Yuankai Kenny Tao
• 金额: $ 37.77万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9803346
• 关键词: 4D Imaging; Adoption; Adult; Affect; Age related macular degeneration; American; Biomechanics; Blindness; Blood Vessels; Cannulations; Cataract; Clinical; Clinical Research; Clinical Treatment; Clinical Trials; Complex; Computer software; Consumption; Corneal dystrophy; Data; Data Storage and Retrieval; Decision Making; Development; Diabetic Retinopathy; Diagnostic; Engineering; Eye; FDA approved; Feedback; Financial compensation; Foundations; Frequencies; Future; Generations; Genes; Glaucoma; Goals; Gold; Head; Image; Image-Guided Surgery; Imagery; Incidence; Keratoplasty; Lead; Lighting; Membrane; Methods; Microscope; Microscopy; Operative Surgical Procedures; Ophthalmology; Optical Coherence Tomography; Outcome; Performance; Population; Positioning Attribute; Postoperative Period; Prevalence; Procedures; Proliferative Vitreoretinopathy; Protocols documentation; Retinal; Safety; Sampling; Scanning; Speed; Structure; Surgical Specialties; Surgical sutures; Technology; Therapeutic; Time; Tissue imaging; Tissues; United States; Visual impairment; Vitrectomy; aging population; base; bulk motion; clinical Diagnosis; cost; density; fly; follow-up; functional outcomes; image guided; image registration; imaging Segmentation; imaging study; improved; improved outcome; in vivo; in vivo imaging; instrument; interest; multidisciplinary; multimodality; new technology; next generation; novel; programs; real-time images; robot assistance; simulation; standard of care; stem cell therapy; subretinal injection; success; surgery outcome; technology development; tomography

The leading causes of low vision and blindness, which include cataract, glaucoma, age-related macular degeneration, corneal dystrophy, and diabetic retinopathy, 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. Although several recent studies have demonstrated the utility of intraoperative OCT (iOCT) for verifying completion of surgical goals, real-time iOCT feedback is not currently used to guide ophthalmic surgery because of several fundamental limitations of current-generation iOCT technology: (1) Serial cross-sectional OCT does not provide sufficient spatial position and orientation feedback to guide surgery. (2) Video-rate volumetric OCT trades-off sampling density with field-of-view and consistent alignment of small static OCT fields to regions-of-interest is prohibitively difficult during surgical maneuvers. (3) Co-registration of volumetric OCT data with the surgical field is challenging because fiducials are often confounded by the non-uniform illumination and contrast of surgical microscopy. (4) Real-time volumetric OCT visualization is complex and time-consuming, requiring cross-sectional fly-throughs or computationally expensive renderings that occlude subsurface features. We recently developed multimodal intraoperative spectrally encoded coherence tomography and reflectometry (iSECTR) technologies that allows for simultaneous and intrinsically co-registered en face reflectance and cross- sectional OCT imaging. We hypothesize that (1) imaging data from 4D iSECTR of surgical dynamics will benefit surgical decision-making and lead to improved functional outcomes; and (2) integration of imaging, registration, segmentation, and feedback using heads-up display (HUD) visualization will enhance existing and enable novel surgical maneuvers. We have assembled a multidisciplinary team of engineers and clinicians to perform foundational ex vivo and in vivo imaging studies to (1) quantitatively assess the safety and utility of 4D iSECTR- based surgical feedback; and (2) develop novel technologies, feedback mechanisms, and maneuvers that integrate volumetric iSECTR data for image-guided ophthalmic surgery. Comprehensive 4D imaging of tissue- instrument interaction dynamics (AIM 1) provides unprecedent data on structural changes resulting from surgical manipulation that may be predictive of post-operative functional outcomes and enable image-based interrogation of biomechanics and personalized surgical planning. Real-time surgical visualization and guidance (AIM 2) may improve success rates of conventional surgical interventions as well as next-generation gene and stem cell therapies. Image-guided surgery also may be compatible with robotic-assistance and telemanipulation in wide- ranging surgical specialties outside of ophthalmology. Quantitative analysis of intraoperative imaging performance, utility, and clinical value (AIM 3) will motivate future technology development and clinical adoption.

低视力和失明的主要原因，包括白内障，青光眼，与年龄相关的黄斑 退化，角膜营养不良和糖尿病性视网膜病影响超过4000万美国人，并且有一个 估计每年用于临床诊断和治疗的250亿美元成本。视觉障碍的流行 美国40岁及以上的成年人超过3.5％，预计将明显增加 人口衰老。尽管最近的一些研究表明，术中OCT（IOCT）的实用性 验证完成手术目标的实时IOCT反馈目前尚未用于指导眼科手术 由于当前生成IOCT技术的几个基本局限性：（1）串行横截面 OCT不能提供足够的空间位置和方向反馈来指导手术。 （2）视频速率 体积OCT交易的抽样密度与视野和一致的小静态OCT场的一致对齐 在外科手术中，到处都很困难。 （3）体积的共同注册 带有手术领域的数据是具有挑战性的，因为信托通常会被不均匀照明混淆 和手术显微镜的对比度。 （4）实时体积OCT可视化是复杂且耗时的， 需要横断面的飞行或计算昂贵的渲染，以阻塞地下特征。 我们最近开发了多模式术中频谱编码的相干断层扫描和反射测量法 （ISECTR）允许同时且内在共同注射的技术 部分OCT成像。我们假设（1）来自手术动力学4D ISECTR的成像数据将受益 手术决策并导致功能结果改善； （2）成像，注册的整合， 细分和使用头部显示（HUD）可视化的反馈将增强现有并启用新颖 外科手术。我们组建了一个由工程师和临床医生组成的跨学科团队来表演 基本的离体和体内成像研究（1）定量评估4D的安全性和效用 基于手术反馈； （2）开发新颖的技术，反馈机制和动作 整合图像引导的眼科手术的体积ISECTR数据。全面的4D组织成像 - 仪器交互动力学（AIM 1）提供了有关手术导致结构变化的前所未有的数据 可以预测术后功能结果并启用基于图像的询问的操作 生物力学和个性化手术计划。实时外科可视化和指导（AIM 2）可能 提高常规手术干预措施以及下一代基因和干细胞的成功率 疗法。图像引导的手术也可能与宽 - 在眼科之外的手术专业。术中成像的定量分析 性能，公用事业和临床价值（AIM 3）将激发未来的技术开发和临床采用。