A New Surgical Dimension: Intra-operative OCT
20 years ago, I was researching the world’s first commercially available OCT (Optical Coherence Tomography) scanner for my MD thesis in London. The pictures were grainy, indistinct, difficult to interpret and took a few seconds to take. At that time I wondered about the possibility of having an OCT scanner available in the operating theatre to help during surgery. just become a reality and I used an OCT scanner during an operation for the first time last week. This intra-operative OCT microscope is the only one in Australia and is currently on trial in the Vision Day Surgery in Box Hill.
During my trial with the intra-operative OCT, I used a new version of the operating microscope that we already have. It displays a real-time live OCT image in one of the eyepieces of the microscope so that the surgeon can see the retina and OCT at the same time. It’s very similar to the ‘head-up display’ in fighter planes and some modern cars.
Standard epiretinal membrane (scar on the surface of the macula) peeling during a vitrectomy operation involves injecting a blue dye into the eye, which stains the transparent membrane and helps the surgeon see it. It can be difficult to know whether the whole membrane has been removed and surgeons often stain again once or twice to be sure, sometimes even trying to peel again to be sure.
The live OCT images helped me avoid further staining and peeling, which almost certainly makes the surgery safer for the patient. A diabetic patient on whom I operated last week also avoided some unnecessary laser as result of the OCT images.
The intra-operative OCT is a great tool which literally adds a whole extra dimension to my surgical technique and decision making. The patient’s risk of surgery may well be reduced using the live OCT images. I have already reviewed videos of my surgery and will look at more that I do over the next week or so; l may refine my surgical technique as a result.