Xu Huan, Fang Wangyi, Liu Guangxing, Fan Jinyu, Yu Jian, Zong Yuan, Jiang Chunhui, Shi Guohua, Sun Xinghuai
Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.
Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
Ann Transl Med. 2020 Dec;8(23):1577. doi: 10.21037/atm-20-3469.
Several researchers have used commercial microscope-integrated optical coherence tomography (OCT) systems in glaucoma surgery, including trabeculectomy and canaloplasty. However, the 840 nm wavelength light source of the OCT systems is not ideal for imaging the anterior chamber angle structures because of its limited penetration. We evaluated the potential value of a microscope-integrated swept-source OCT system with a 1,310 nm center-wavelength light in canaloplasty for glaucoma.
Sixteen porcine eyes were used to simulate canaloplasty. The critical surgical steps were monitored using a prototype microscope-integrated OCT system with a 1,310 nm light source and a high axial scan rate of 100 kHz. The images from swept-source OCT and three-dimensional images from the microscope were projected simultaneously onto a liquid crystal display three-dimensional monitor (LMD-4251TD, Sony, Japan). The changes in the collector vessel (aqueous drainage structure in the porcine eye, similar to Schlemm's canal in humans) were measured using Image J software. Histological sections stained with hematoxylin and eosin were used to assess surgical efficacy.
High-resolution real-time images of the anterior segment were acquired during canaloplasty using the microscope-integrated OCT system. With the real-time OCT images, the position of the collector vessel was identified and the scleral flap could be created at the ideal location. The expansion of the collector vessel after viscoelastic injection was also visualized in real time. Compared with baseline, there was a significant increase in the cross-sectional area (from 14,502.98±9,242.55 to 59,499.04±20,506.41 µm, P<0.001) of the collector vessel.
Using the microscope-integrated OCT system, real-time images of the anterior segment were successfully acquired during the operation. The microscope-integrated OCT system might be useful in future anti-glaucoma surgery.
几位研究人员已在青光眼手术（包括小梁切除术和睫状体光凝术）中使用了商业显微镜集成光学相干断层扫描（OCT）系统。然而，OCT系统的840nm波长光源由于其穿透有限，对于眼前房角结构成像并不理想。我们评估了一种中心波长为1310nm的显微镜集成扫频源OCT系统在青光眼睫状体光凝术中的潜在价值。
使用16只猪眼模拟睫状体光凝术。使用具有1310nm光源和100kHz高轴向扫描速率的原型显微镜集成OCT系统监测关键手术步骤。扫频源OCT的图像和显微镜的三维图像同时投影到液晶显示器三维监视器（LMD - 4251TD，索尼，日本）上。使用Image J软件测量收集管（猪眼中的房水引流结构，类似于人类的施莱姆管）的变化。用苏木精和伊红染色的组织切片用于评估手术效果。
在睫状体光凝术期间，使用显微镜集成OCT系统获得了眼前节的高分辨率实时图像。借助实时OCT图像，确定了收集管的位置，并可在理想位置制作巩膜瓣。还实时观察到粘弹剂注射后收集管的扩张。与基线相比，收集管的横截面积显著增加（从14,502.98±9,242.55增加到59,499.04±20,506.41µm，P<0.001）。
使用显微镜集成OCT系统，在手术过程中成功获得了眼前节的实时图像。显微镜集成OCT系统可能在未来的抗青光眼手术中有用。
