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    Introducing 3-D OCT to live surgery

    Technology may provide retina surgeons ability to do more precise vitrectomy

    Take-home message: The advent of three-dimensional optical coherence tomography to live surgery may bring greater clarity to how ophthalmologists visualize structures and how they operate.

    Reviewed by Pravin U. Dugel, MD

    No doubt the commercialization of optical coherence tomography (OCT) has forever changed the clinical management of retinal disorders. Its introduction into the surgical realm may be a game changer in its own right, said Pravin U. Dugel, MD. 

    Modern microscopes limit the surgeon’s view, and “axial information must be inferred from instrument shadowing and other indirect cues.”

    As advances in OCT technology have increased the ability of these devices to image ocular structures better, the category as a whole has moved into a wide variety of applications, including the ability to assess subretinal fluid, pigment epithelial detachments, and choroidal neovascular membranes.

    Microscope-integrated OCT systems use spectral-domain OCT to “capture” live two-dimensional OCT images during surgery and provide viewing of three-dimensional (3-D) volumes on an external screen.

    “There is a lot of misunderstanding around 3-D OCT technology,” said Dr. Dugel, managing partner, Retinal Consultants of Arizona, Phoenix, and clinical professor, University of Southern California Eye Institute, Keck School of Medicine, Los Angeles. “It involves putting the image on an AV screen in a digital format and not looking through the microscope. There is a great deal of misconception as to why this is important.”

    Though there are some ergonomic benefits, “those are really almost immaterial—they are very minor advantages,” said Dr. Dugel, who is also a member of the Ophthalmology Times Editorial Advisory Board.

    The 'game changer'

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