Author: Austen Knapp (United States)
Co-authors: Katherine Talcott, Sunil Srivastava, Aleksandra Rachitskaya Rachitskaya, Sumit Sharma, Jamie Reese, Justis Ehlers
Purpose
The recent technological evolution in surgical microscopes has brought new digitally-enabled options for high-definition, heads-up stereoscopic visualization during posterior segment surgery. Surgical efficiency, ergonomics, patient safety, and new surgeon education in vitreoretinal surgery may be enhanced with this technology but there is limited literature in this area. In this analysis, a comparative assessment of surgeon experience between conventional microscope-integrated intraoperative optical coherence tomography (iOCT) and a digitally-enabled microscope-integrated iOCT surgical platform in vitreoretinal surgery was performed.
Setting/Venue
This study was conducted at a single, academic institution with multiple vitreoretinal surgeons involved.
Methods
This was a post-hoc case-control analysis from the DISCOVER study - a prospective, multi-surgeon case series - comparing the use of two different microscope-integrated OCT (iOCT) platforms. One group consisted of eyes that underwent surgery with a conventional microscope-integrated iOCT (Rescan 700 Prototype; Carl Zeiss Meditec, Oberkochen, Germany), while the second group of eyes underwent surgery with a digitally-enabled iOCT (Artevo 800; Carl Zeiss Meditec, Oberkochen, Germany). When feasible, the two groups were matched for surgeon and preoperative diagnosis (i.e., surgical indication). Standardized surgeon questionnaires were collected immediately following surgery. Variables examined included patient demographics, indication for surgery, endoillumination levels, utilization and visualization of iOCT, surgeon feedback on viewing quality, and impact of iOCT on surgical decisions. Visualization and review of the iOCT datasteam was evaluated based on the following options: surgical-field based visualization (i.e., ocular heads-up display in the conventional group, 3D screen-based visualization in the digitally-enabled group) and non-surgical field-based (i.e., review on the external monitor (Callisto)). Inclusion criteria included age of 18 years or older and planned vitreoretinal surgery. Statistical analysis included t-tests to compare continuous variables and Chi-square and Fisher’s exact tests to compare categorical variables.
Results
173 eyes from 173 patients were analyzed. 78 patients (mean age 64.8 ± 10.9 years) composed the conventional iOCT group and 95 (mean age 64.1 ± 14.2 years) composed the digital iOCT group. The most common indications for surgery were epiretinal membrane (conventional iOCT = 29.5%; digital iOCT = 33.7%) followed by retinal detachment and full thickness macular hole (conventional iOCT = 26.9%, 17.9%; digital iOCT = 23.2%, 19.0% respectively). Surgical field-based visualization of iOCT datastream was significantly higher in the digitally-enabled group compared with conventional iOCT group (85.2% vs 11.4%, p <0.0001). The required endoillumination level was significantly lower in the digital iOCT group (34 % vs 37.1 %, p= 0.0007). Surgeon-perceived utility of iOCT was similar between groups (conventional iOCT = 50%; digital iOCT = 58.9%, p = 0.234). The direct impact of iOCT on surgical decision-making was also similar between both groups (12.8% vs 21.1%, p=0.155) although there was a trend towards greater impact in the digital iOCT group.
Conlusions
Digitally-enabled microscope-integrated iOCT resulted in greater surgical visualization efficiency with a significantly higher proportion of cases with surgical-field based visualization of the iOCT datastream compared to the conventional system. The digital iOCT display also appeared to require a lower illumination level for performance of surgical tasks. Surgeon-perceived utility of iOCT was high in both groups.
Financial Disclosure
NA
Comments
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