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四维度显微镜整合于模型眼视网膜下手术之光学同调断层扫描引导

Four-Dimensional Microscope-Integrated Optical Coherence Tomography Guidance in a Model Eye Subretinal Surgery.

机构信息

Departments of Ophthalmology.

Biomedical Engineering, and.

出版信息

Retina. 2019 Oct;39 Suppl 1(Suppl 1):S194-S198. doi: 10.1097/IAE.0000000000002518.

DOI:10.1097/IAE.0000000000002518
PMID:31090685
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6778454/
Abstract

PURPOSE

: Subretinal delivery of stem cells and gene therapy vectors hold great promise in clinical care. Delivery techniques are evolving. We investigate the utility of 4-dimensional (volumes over time) microscope-integrated optical coherence tomography (4D-MIOCT) to guide such maneuvers.

METHODS

: This investigational 4D-MIOCT system displayed heads-up cross-sectional and stereoscopic volumetric views through the microscope oculars at 3.3–10 volumes/second. In enucleated porcine eyes, we evaluated novel information available to the surgeon during subretinal: 1) injection of fluid and cell suspensions, 2) retinotomy creation, 3) insertion of membranes with a retinal pigment epithelium (RPE) cell monolayer and 4) subretinal instrument maneuvers, all in postmortem porcine eyes.

RESULTS

: Interactions between tools, membranes, retina and RPE were often not detectable on the conventional microscope view but were obvious with 4D-MIOCT. 4D-MIOCT visualization essential to: monitor the extent of induced retinal detachment, guide the cannula tip and instrument maneuvers in the subretinal space, and identify efflux of cells into the vitreous cavity. This allowed adjustment by the surgeon to avoid complications—e.g. scissors scraping RPE.

CONCLUSIONS

: 4D-MIOCT is useful for continuous monitoring of model subretinal surgery and may help avoid technique-related complications. 4D-MIOCT can contribute to the advancement of subretinal delivery of therapies under development.

摘要

目的

视网膜下递送干细胞和基因治疗载体在临床护理中有很大的应用前景。递送技术正在不断发展。我们研究了 4 维（随时间变化的体积）显微镜集成光相干断层扫描（4D-MIOCT）在指导这些操作中的应用。

方法

这个研究性的 4D-MIOCT 系统通过显微镜目镜以 3.3-10 个体积/秒的速度显示抬头式横截面和立体体积视图。在眼球摘除的猪眼内，我们评估了在视网膜下手术中外科医生可获得的新信息：1）注射流体和细胞悬浮液，2）视网膜切开术的创建，3）插入带有视网膜色素上皮（RPE）单层的膜，以及 4）视网膜下仪器操作，所有这些都在死后的猪眼内进行。

结果

工具、膜、视网膜和 RPE 之间的相互作用在常规显微镜下通常无法检测到，但在 4D-MIOCT 下则非常明显。4D-MIOCT 可视化对于：监测诱导性视网膜脱离的程度、引导视网膜下空间内的套管尖端和仪器操作、以及识别细胞进入玻璃体腔的流出，这是必不可少的。这使得外科医生可以进行调整以避免并发症，例如剪刀刮擦 RPE。

结论

4D-MIOCT 对于模型视网膜下手术的连续监测非常有用，并可能有助于避免与技术相关的并发症。4D-MIOCT 可以为正在开发的视网膜下递送疗法的进展做出贡献。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eea7/6778454/7d0ae4db51bf/nihms-1048350-f0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eea7/6778454/11a2172f518b/nihms-1048350-f0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eea7/6778454/5c7aed190bfb/nihms-1048350-f0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eea7/6778454/0a930bae045b/nihms-1048350-f0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eea7/6778454/7d0ae4db51bf/nihms-1048350-f0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eea7/6778454/11a2172f518b/nihms-1048350-f0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eea7/6778454/5c7aed190bfb/nihms-1048350-f0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eea7/6778454/0a930bae045b/nihms-1048350-f0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eea7/6778454/7d0ae4db51bf/nihms-1048350-f0004.jpg

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