Intraocular OCT Real-time Monitoring of Laser Retinectomy

Vanderbilt University, Nashville TN

Investigators

Linked publications & trials

Abstract

DESCRIPTION (provided by applicant): The pioneering of laser surgery and ocular coherence tomography by eye researchers has had a tremendous global health impact upon the current ability to diagnose, understand, treat, and monitor multiple eye diseases. The potential of combining these two powerful modalities into a miniature intraocular probe to monitor and guide real-time laser surgery is untapped. Advances in surgical outcomes will occur with new devices to increase the technical precision of surgeons. This project proposes that a system with a miniature probe can be developed that monitors real-time incision of a tissue layer to protect the underlying tissues from injury. To achieve precise image-guided incisions, a customized real-time spectral domain optical coherence tomography (SDOCT) imaging system will be combined with a novel table-top 6.1 <m mid-infrared (IR) incising laser for delivery through miniature 20-gauge prototype probes. This technology will be developed and applied to retinectomy. Incising retina adjacent to anteriorly located proliferative vitreoretinopathy to achieve retinal re- attachment is technically challenging. This technique is being more frequently employed with the increasing prevalence of uncontrolled diabetes in the population and the advent of severe ocular trauma from improvised explosive devices. Initial evaluation of the prototypes will occur on artificially detached porcine retinas. The imaging and lasing spots will overlap on the target tissue to permit real-time imaging of tissue layer ablation as the incision proceeds to the subretinal space. As this occurs, the probe will be moved to an adjacent location to permit continued incision of the retina while preventing damage to underlying retinal pigment epithelium. All incisions will be examined histologically to evaluate for thermal injury, to inspect underlying tissue structures, and to compare to the SDOCT signal profile in order to guide modification of the probes for optimal performance. Upon proposal completion, a hand-held combined SDOCT imaging/ IR laser/ diathermy probe and system will be ready to verify in an animal study. Hypothesis: A system with a miniature probe can be developed that monitors real-time incision of a tissue layer to protect the underlying tissues from injury. Aim I. An IR laser waveguide probe and a novel SDOCT imaging probe will be developed and then combined into an ergonomic 20-gauge probe for intraocular surgery. Aim II. Optimize and demonstrate feasibility of the SDOCT system to evaluate real-time laser incising of artificially detached retinas (retinectomy procedure) delivered through the 20-gauge probe. PUBLIC HEALTH RELEVANCE: The goal is to achieve safe image-guided incisions by combining light-imaging technology with an incising laser in a miniature probe. The imaging will be exploited to detect incision of a tissue layer as it occurs to protect the underlying structures from injury. This concept will be explored in a retinal intraocular procedure, but has profound relevance for multiple surgical areas.