Author: Alan Franklin (United States)
Co-authors: Athanasios Nikolakopoulos, Chris Riemann, Jessica McCluskey, Steven Houston, Lauren Gibson
Purpose
Precise identification and subsequent delamination of pre-retinal membranes is a core skill required for almost every retinal surgery. It is also important to minimize toxicity of high concentrations dyes used to stain these membranes. Manipulation of the digital image in real time has the potential to both improve edge detection and decrease dye concentration.
Setting/Venue
Retrospective image analysis of different digital filters used during macular surgery in a private practice setting.
Methods
This is a retrospective review of images captured during retinal surgery for patients who underwent epiretinal membrane delamination. Still image captures during DAVS retinal surgery were taken with either standard constellation visualization filter, yellow thumbnail, green or blue enhancing filters, and the images to be compared were captured within 3 seconds of each other. The image pairs were converted to grey scale or CIELab Color Space for calculations of contrast and color difference, respectively. A linear sample taken perpendicular to edge of peeled and unpeeled tissue was analyzed for gray scale and color difference calculations.
Results
The blue enhancing digital filter effectively increased both the gray scale contrast by approximately 40% and the CIE color difference by 9, at the edge of peeled and unpeeled retina after staining with TissueBlue®. Both of these signals were highly significant, p < 0.05. Less of a signal difference was observed with the yellow thumbnail setting, NGENUITY Version 1.4, but a significant difference in CIE color difference is anticipated based on the trend and the relatively low number of eyes analyzed. The green enhancing digital filter effectively increased both the gray scale contrast by approximately 15% and the CIE color difference by 2, at the edge of peeled and unpeeled retina after staining with ICG. Both of these signals were highly significant, p < 0.05. Relatively dilute ICG 0.1% was used and the stain was applied for less than 30 seconds. Similar to that observed with TissueBlue®, the yellow thumbnail did show a trend for contrast and CIE color difference enhancement.
Conlusions
Digital filters significantly enhance edge detection of peeled and unpeeled retina by increasing both gray scale and CIE color difference. In addition, this enhanced signal permits lower exposure to ICG dye to achieve adequate visualization. These data show promise that digital visualization during retinal surgery will ultimately minimize dye exposure and trauma to the retina.
Financial Disclosure
Alcon Consultant and Grant Support AsclepiX Consultant Scanoptix Consultant ForwardVue Pharma Founder
Comments
-
