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、年龄相关性黄斑 变性、角膜营养不良和糖尿病性视网膜病变影响着超过 4000 万美国人，并且 预计每年临床诊断和治疗费用为 250 亿美元。视力障碍的患病率 美国 40 岁及以上成年人的这一比例超过 3.5%，并且由于以下原因预计将显着增加 人口老龄化。尽管最近的几项研究已经证明了术中 OCT (iOCT) 的实用性 验证手术目标的完成情况，实时 iOCT 反馈目前尚未用于指导眼科手术 由于当前一代 iOCT 技术的几个基本限制：（1）串行横截面 OCT 无法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 权衡采样密度与视野以及小静态 OCT 场的一致对准 在手术操作过程中，到达感兴趣区域是非常困难的。 (3) 体积OCT联合配准 手术野的数据具有挑战性，因为基准点经常被不均匀的照明所混淆 和手术显微镜的对比。 (4) 实时体OCT可视化复杂且耗时， 需要横截面飞行或计算昂贵的渲染来遮挡地下特征。 我们最近开发了多模式术中光谱编码相干断层扫描和反射测量 (iSECTR) 技术，允许同时和本质上共同配准正面反射和交叉 断层 OCT 成像。我们假设 (1) 手术动力学的 4D iSECTR 成像数据将受益 手术决策并改善功能结果； (2) 成像、配准、 使用平视显示器 (HUD) 可视化进行细分和反馈将增强现有技术并实现新颖的 外科手术操作。我们组建了一支由工程师和临床医生组成的多学科团队来执行 基础离体和体内成像研究，以 (1) 定量评估 4D iSECTR- 的安全性和实用性 基于手术反馈； (2) 开发新技术、反馈机制和策略 集成体积 iSECTR 数据以进行图像引导眼科手术。组织的全面 4D 成像 - 仪器相互作用动力学（AIM 1）提供了有关手术引起的结构变化的前所未有的数据 可以预测术后功能结果并实现基于图像的询问的操作 生物力学和个性化手术计划。实时手术可视化和指导 (AIM 2) 可以 提高传统手术干预以及下一代基因和干细胞的成功率 疗法。图像引导手术还可以与机器人辅助和远程操作兼容。 范围涵盖眼科以外的外科专业。术中影像定量分析 性能、实用性和临床价值（AIM 3）将推动未来的技术开发和临床采用。