Intraoperative OCT: It’s the Real Deal

This past year, I upgraded from the ZEISS ARTEVO 800 to the ZEISS ARTEVO 850 with intraoperative optical coherence tomography (iOCT). At first, I questioned adding yet another technology to my OR—the last thing I needed during a delicate retinal procedure was a distraction of unclear value. But almost immediately after using iOCT in my surgical practice, the verdict was in: the addition of iOCT to the surgical suite is a game changer for me and my patients.

Recent innovations in iOCT—including enhanced image quality and an intuitive user interface—confer significant clinical benefit while enhancing precision and efficiency. This emerging technology has evolved beyond a mere research tool and is primed to become a part of routine surgical protocols.

Are you on the fence about adding iOCT to your OR? If so, consider how much you value these benefits, all of which were enhanced after I adopted ZEISS ARTEVO 850 in my surgical center.

Image Quality: I was immediately impressed by the iOCT image quality on ZEISS ARTEVO 850. In a recent operation for macula-threatening retinal detachment during which I employed iOCT, I observed in real time that fluid was headed toward the macula. Within the ZEISS ARTEVO 850 interface, I created a linear demarcation to track fluid creep. Without iOCT on ZEISS ARTEVO 850, I would never have been able to appreciate that level of detail.
Changing Anatomic Fluid Dynamics: When you rely solely on traditional OCT printouts to reorient yourself to a patient case prior to surgery, you accept that some things may have changed in the lag time between the point of image capture and the operation itself. Anatomic fluid can change between those two time points, even within a short window. With iOCT on ZEISS ARTEVO 850, I now assess the patient’s anatomy immediately prior to surgery, giving me the most up-to-date snapshot of the ocular anatomy.

Precision: My surgical movements are much more precise when using iOCT. Consider a difficult membrane peel. I review instrument placement and tissue layers on the screen in real-time just before I initiate a peel. This makes for safer surgery, as I can see exactly which tissue to target and the location of my instruments relative to my targeted tissue.

Efficiency: Depending on your practice, you may bring OCT printouts to the OR or dial into your OCT platform via remote access. If you forget the printouts or have connectivity issues, your orientation to the case will be based on memory alone. With iOCT, these potential snags vanish. By relying on preoperative imaging captured immediately before surgery, you’ll know the exact anatomy of the patient before initiating surgery, and you won’t have to waste time reviewing clinical OCTs prior to surgery.

Simplicity: I mentioned my hesitation in adding distractions to the OR. ZEISS ARTEVO 850 addresses this challenge in two ways. First, you can turn the iOCT screen off or on during the procedure, so it doesn’t constantly occupy valuable space on the screen. I utilize it when I need it, then simply disable it to limit distractions. Second, there’s no interaction between the surgeon and iOCT other than viewing the screen. ZEISS ARTEVO 850 auto-calibrates to find the clearest image, so there’s no manual zooming and I can easily change the position with the foot pedal. With the simple design of the foot pedal and auto-calibration, I can look at the eye from nearly any angle. And all in real time.

In my experience, nearly all procedures benefit from iOCT on ZEISS ARTEVO 850. However, if you’re just getting started, build comfort with iOCT by applying it to macular hole repairs, epiretinal membrane peels, and retinal detachment surgeries. You may also find early utility when peeling peripheral proliferative vitreoretinopathy membranes, which are notoriously difficult to image on clinical OCT, but which are depicted clearly on iOCT.

Whether you’re hesitant to add another screen to your OR, are skeptical of the contribution iOCT will bring to your surgeries, or only think of iOCT as a research tool, it’s time to reframe your thinking. iOCT is an invaluable asset that has tangibly improved surgical outcomes for my patients. When you’re ready to upgrade your OR to include iOCT, consider how elegantly ZEISS ARTEVO 850 will fit into your clinic.

Want more? Hear other clinicians’ perspectives on iOCT in routine surgical applications at this webinar featuring leading experts in anterior and posterior segment surgery.