Introduction:
Intraoperative Optical Coherence Tomography (OCT) has emerged as a promising tool to revolutionize ophthalmic surgery. The PIONEER study was initiated to thoroughly evaluate the practicality, safety, and effectiveness of intraoperative OCT in diverse ophthalmic surgical procedures. This prospective, consecutive case series aimed to determine the utility of microscope-mounted spectral-domain OCT systems during both anterior and posterior segment surgeries.
Methods and Procedures:
The PIONEER study, conducted at a single center over two years, enrolled 531 eyes, encompassing 275 anterior segment and 256 posterior segment surgical cases. Utilizing a microscope-mounted spectral-domain OCT system, intraoperative scanning was performed, employing disease and procedure-specific imaging protocols. Surgeon feedback was meticulously collected immediately post-surgery to ascertain the perceived utility of intraoperative OCT and its impact on surgical understanding and decision-making.
Key Findings from Pioneer Optical Study:
Intraoperative OCT imaging was successfully obtained in an impressive 98% of cases (518 out of 531 eyes), demonstrating the feasibility and reliability of the technology in a surgical setting. Surgeon feedback highlighted the significant influence of intraoperative OCT on surgical approaches. Notably, in lamellar keratoplasty procedures, intraoperative OCT informed surgical decision-making in 48% of 144 cases, and in membrane peeling procedures, this figure reached 43% of 146 cases. Descemet stripping automated endothelial keratoplasty (DSAEK) was the most frequent anterior segment procedure (n=135), while vitrectomy with membrane peeling was most common for posterior segment surgeries (n=154). The time taken to perform intraoperative OCT scans was minimal, with a median pause of just 4.9 minutes per scan session. Critically, no adverse events were directly linked to the use of intraoperative OCT during any procedure, underscoring its safety.
Conclusion:
The PIONEER study definitively establishes intraoperative OCT as a feasible and safe technology across a broad spectrum of anterior and posterior segment ophthalmic surgical procedures. The integration of a microscope-mounted intraoperative OCT system allows for efficient real-time imaging during operations. The insights gained from intraoperative OCT have a substantial impact on surgical decision-making in a significant proportion of both anterior and posterior segment cases, suggesting its potential to enhance surgical outcomes and improve patient care in ophthalmic surgery.
