1. Articles from Brenton Keller

    1-22 of 22
    1. Optical Coherence Tomography Guided Robotic Needle Insertion for Deep Anterior Lamellar Keratoplasty

      Optical Coherence Tomography Guided Robotic Needle Insertion for Deep Anterior Lamellar Keratoplasty

      Objective: Deep anterior lamellar keratoplasty (DALK) significantly reduces the post-transplantation morbidity in patients eligible for partial-thickness cornea grafts. The popular "big bubble" technique for DALK is so challenging, however, that a significant fraction of corneal pneumodissection attempts fail for surgeons without extensive DALK-specific experience, even with previous-generation cross-sectional optical coherence tomography (OCT) guidance. We seek to develop robotic, volumetric OCT-guided technology capable of facilitating or automating the difficult needle insertion step in DALK. Methods: Our system provides for real-time volumetric corneal imaging, segmentation, and tracking of the needle insertion to display feedback for surgeons and to generate needle insertion plans ...

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    2. Feature of the Week 06/24/2018: Duke University Researchers Show Exciting Advances in Live OCT Volumes in Immersive Virtual Reality

      Feature of the Week 06/24/2018: Duke University Researchers Show Exciting Advances in Live OCT Volumes in Immersive Virtual Reality

      Virtual reality (VR) head-mounted displays are an attractive technology for viewing intrasurgical optical coherence tomography (OCT) volumes because they liberate surgeons from microscope oculars. We demonstrate real-time, interactive viewing of OCT volumes in a commercial HTC Vive immersive VR system using previously reported ray casting techniques. Furthermore, we show interactive manipulation and sectioning of volumes using handheld controllers and guidance of mock surgical procedures in porcine eyes exclusively within VR. To the best of our knowledge, we report the first immersive VR-OCT viewer with stereo ray casting volumetric renders, arbitrary sectioning planes, and live acquisition support. We believe VR-OCT volume ...

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    3. Real-time visualization and interaction with static and live optical coherence tomography volumes in immersive virtual reality

      Real-time visualization and interaction with static and live optical coherence tomography volumes in immersive virtual reality

      Virtual reality (VR) head-mounted displays are an attractive technology for viewing intrasurgical optical coherence tomography (OCT) volumes because they liberate surgeons from microscope oculars. We demonstrate real-time, interactive viewing of OCT volumes in a commercial HTC Vive immersive VR system using previously reported ray casting techniques. Furthermore, we show interactive manipulation and sectioning of volumes using handheld controllers and guidance of mock surgical procedures in porcine eyes exclusively within VR. To the best of our knowledge, we report the first immersive VR-OCT viewer with stereo ray casting volumetric renders, arbitrary sectioning planes, and live acquisition support. We believe VR-OCT volume ...

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    4. Microscope-Integrated Optical Coherence Tomography Angiography in the Operating Room in Young Children With Retinal Vascular Disease

      Microscope-Integrated Optical Coherence Tomography Angiography in the Operating Room in Young Children With Retinal Vascular Disease

      Importance Intraoperative optical coherence tomography (OCT) has gained traction as an important adjunct for clinical decision making during vitreoretinal surgery, and OCT angiography (OCTA) has provided novel insights in clinical evaluation of retinal diseases. To date, these two technologies have not been applied in combination to evaluate retinal vascular disease in the operating suite. Objective To conduct microscope-integrated, swept-source OCTA (MIOCTA) in children with retinal vascular disease. Design, Setting, and Participants In this case report analysis, OCT imaging in pediatric patients, MIOCTA images were obtained during examination under anesthesia from a young boy with a history of idiopathic vitreous hemorrhage ...

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    5. Four-dimensional microscope- integrated optical coherence tomography to enhance visualization in glaucoma surgeries

      Four-dimensional microscope- integrated optical coherence tomography to enhance visualization in glaucoma surgeries

      We report the first use of swept-source microscope-integrated optical coherence tomography (SS-MIOCT) capable of live four-dimensional (4D) (three-dimensional across time) imaging intraoperatively to directly visualize tube shunt placement and trabeculectomy surgeries in two patients with severe open-angle glaucoma and elevated intraocular pressure (IOP) that was not adequately managed by medical intervention or prior surgery. We performed tube shunt placement and trabeculectomy surgery and used SS-MIOCT to visualize and record surgical steps that benefitted from the enhanced visualization. In the case of tube shunt placement, SS-MIOCT successfully visualized the scleral tunneling, tube shunt positioning in the anterior chamber, and tube shunt ...

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    6. Review of intraoperative optical coherence tomography: technology and applications [Invited]

      Review of intraoperative optical coherence tomography: technology and applications [Invited]

      During microsurgery, en face imaging of the surgical field through the operating microscope limits the surgeon’s depth perception and visualization of instruments and sub-surface anatomy. Surgical procedures outside microsurgery, such as breast tumor resections, may also benefit from visualization of the sub-surface tissue structures. The widespread clinical adoption of optical coherence tomography (OCT) in ophthalmology and its growing prominence in other fields, such as cancer imaging, has motivated the development of intraoperative OCT for real-time tomographic visualization of surgical interventions. This article reviews key technological developments in intraoperative OCT and their applications in human surgery. We focus on handheld ...

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    7. Four-dimensional Microscope-Integrated Optical Coherence Tomography to Visualize Suture Depth in Strabismus Surgery

      Four-dimensional Microscope-Integrated Optical Coherence Tomography to Visualize Suture Depth in Strabismus Surgery

      The authors report the use of swept-source microscope-integrated optical coherence tomography (SS-MIOCT), capable of live four-dimensional (three-dimensional across time) intraoperative imaging, to directly visualize suture depth during lateral rectus resection. Key surgical steps visualized in this report included needle depth during partial and full-thickness muscle passes along with scleral passes.

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    8. Wireless, Web-Based Interactive Control of Optical Coherence Tomography with Mobile Devices

      Wireless, Web-Based Interactive Control of Optical Coherence Tomography with Mobile Devices

      Purpose : Optical coherence tomography (OCT) is widely used in ophthalmology clinics and has potential for more general medical settings and remote diagnostics. In anticipation of remote applications, we developed wireless interactive control of an OCT system using mobile devices. Methods : A web-based user interface (WebUI) was developed to interact with a handheld OCT system. The WebUI consisted of key OCT displays and controls ported to a webpage using HTML and JavaScript. Client–server relationships were created between the WebUI and the OCT system computer. The WebUI was accessed on a cellular phone mounted to the handheld OCT probe to wirelessly ...

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    9. Enhanced visualization of peripheral retinal vasculature with wavefront sensorless adaptive optics optical coherence tomography angiography in diabetic patients

      Enhanced visualization of peripheral retinal vasculature with wavefront sensorless adaptive optics optical coherence tomography angiography in diabetic patients

      Optical coherence tomography angiography (OCTA) is a promising technique for non-invasive visualization of vessel networks in the human eye. We debut a system capable of acquiring wide field-of-view ( > 70 ° >70° ) OCT angiograms without mosaicking. Additionally, we report on enhancing the visualization of peripheral microvasculature using wavefront sensorless adaptive optics (WSAO). We employed a fast WSAO algorithm that enabled wavefront correction in < 2    s <2  s by iterating the mirror shape at the speed of OCT B-scans rather than volumes. Also, we contrasted ∼ 7 ° ∼7° field-of-view OCTA angiograms acquired in the periphery with and without WSAO correction. On average, WSAO improved ...

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    10. Wide-field retinal optical coherence tomography with wavefront sensorless adaptive optics for enhanced imaging of targeted regions

      Wide-field retinal optical coherence tomography with wavefront sensorless adaptive optics for enhanced imaging of targeted regions

      The peripheral retina of the human eye offers a unique opportunity for assessment and monitoring of ocular diseases. We have developed a novel wide-field (>70°) optical coherence tomography system (WF-OCT) equipped with wavefront sensorless adaptive optics (WSAO) for enhancing the visualization of smaller (<25°) targeted regions in the peripheral retina. We iterated the WSAO algorithm at the speed of individual OCT B-scans (~20 ms) by using raw spectral interferograms to calculate the optimization metric. Our WSAO approach with a 3 mm beam diameter permitted primarily low- but also high- order peripheral wavefront correction in less than 10 seconds. In preliminary ...

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    11. Needle Depth and Big-Bubble Success in Deep Anterior Lamellar Keratoplasty: An Ex Vivo Microscope-Integrated OCT Study

      Needle Depth and Big-Bubble Success in Deep Anterior Lamellar Keratoplasty: An Ex Vivo Microscope-Integrated OCT Study

      Purpose: To examine big-bubble (BB) formation success rates in deep anterior lamellar keratoplasty (DALK) at various corneal depths using real-time guidance from swept-source, microscope-integrated optical coherence tomography (SS-MIOCT). Methods: The DALK procedure was performed ex vivo with 34 human donor corneoscleral buttons on pressurized artificial anterior chambers using the BB technique employed by Anwar and Teichmann. We inserted a needle under controlled ex vivo conditions to corneal depths ranging from 40% to ≥90% using real-time guidance from SS-MIOCT and injected air. BB success was then determined for each injection. Results: The average needle depth for successful full BB formation was ...

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    12. Pupil Tracking for Real-Time Motion Corrected Anterior Segment Optical Coherence Tomography

      Pupil Tracking for Real-Time Motion Corrected Anterior Segment Optical Coherence Tomography

      Volumetric acquisition with anterior segment optical coherence tomography (ASOCT) is necessary to obtain accurate representations of the tissue structure and to account for asymmetries of the anterior eye anatomy. Additionally, recent interest in imaging of anterior segment vasculature and aqueous humor flow resulted in application of OCT angiography techniques to generate en face and 3D micro-vasculature maps of the anterior segment. Unfortunately, ASOCT structural and vasculature imaging systems do not capture volumes instantaneously and are subject to motion artifacts due to involuntary eye motion that may hinder their accuracy and repeatability. Several groups have demonstrated real-time tracking for motion-compensated in ...

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    13. Length-adaptive graph search for automatic segmentation of pathological features in optical coherence tomography images

      Length-adaptive graph search for automatic segmentation of pathological features in optical coherence tomography images

      We introduce a metric in graph search and demonstrate its application for segmenting retinal optical coherence tomography (OCT) images of macular pathology. Our proposed “adjusted mean arc length” (AMAL) metric is an adaptation of the lowest mean arc length search technique for automated OCT segmentation. We compare this method to Dijkstra’s shortest path algorithm, which we utilized previously in our popular graph theory and dynamic programming segmentation technique. As an illustrative example, we show that AMAL-based length-adaptive segmentation outperforms the shortest path in delineating the retina/vitreous boundary of patients with full-thickness macular holes when compared with expert manual ...

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    14. Optical Coherence Tomography for Retinal Surgery: Perioperative Analysis to Real-Time Four-Dimensional Image-Guided Surgery

      Optical Coherence Tomography for Retinal Surgery: Perioperative Analysis to Real-Time Four-Dimensional Image-Guided Surgery

      Magnification of the surgical field using the operating microscope facilitated profound innovations in retinal surgery in the 1970s, such as pars plana vitrectomy. Although surgical instrumentation and illumination techniques are continually developing, the operating microscope for vitreoretinal procedures has remained essentially unchanged and currently limits the surgeon's depth perception and assessment of subtle microanatomy. Optical coherence tomography (OCT) has revolutionized clinical management of retinal pathology, and its introduction into the operating suite may have a similar impact on surgical visualization and treatment. In this article, we review the evolution of OCT for retinal surgery, from perioperative analysis to live ...

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    15. Novel microscope-integrated stereoscopic heads-up display for intrasurgical optical coherence tomography

      Novel microscope-integrated stereoscopic heads-up display for intrasurgical optical coherence tomography

      Intra-operative optical coherence tomography (OCT) requires a display technology which allows surgeons to visualize OCT data without disrupting surgery. Previous research and commercial intrasurgical OCT systems have integrated heads-up display (HUD) systems into surgical microscopes to provide monoscopic viewing of OCT data through one microscope ocular. To take full advantage of our previously reported real-time volumetric microscope-integrated OCT (4D MIOCT) system, we describe a stereoscopic HUD which projects a stereo pair of OCT volume renderings into both oculars simultaneously. The stereoscopic HUD uses a novel optical design employing spatial multiplexing to project dual OCT volume renderings utilizing a single micro-display ...

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    16. 4D microscope-integrated OCT improves accuracy of ophthalmic surgical maneuvers

      4D microscope-integrated OCT improves accuracy of ophthalmic surgical maneuvers

      Ophthalmic surgeons manipulate micron-scale tissues using stereopsis through an operating microscope and instrument shadowing for depth perception. While ophthalmic microsurgery has benefitted from rapid advances in instrumentation and techniques, the basic principles of the stereo operating microscope have not changed since the 1930’s. Optical Coherence Tomography (OCT) has revolutionized ophthalmic imaging and is now the gold standard for preoperative and postoperative evaluation of most retinal and many corneal procedures. We and others have developed initial microscope-integrated OCT (MIOCT) systems for concurrent OCT and operating microscope imaging, but these are limited to 2D real-time imaging and require offline post-processing for ...

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    17. Real-Time Microscope-Integrated OCT to Improve Visualization in DSAEK for Advanced Bullous Keratopathy

      Real-Time Microscope-Integrated OCT to Improve Visualization in DSAEK for Advanced Bullous Keratopathy

      Purpose: To report the intraoperative use of microscope-integrated optical coherence tomography (MIOCT) to enable visualization for Descemet's stripping automated endothelial keratoplasty (DSAEK) in 2 patients with advanced bullous keratopathy. Methods: Patient 1 was an 83-year-old female and patient 2 was a 28-year-old male both with limited vision and significant pain from bullous keratopathy who underwent palliative DSAEK. Because of the severity and chronicity of the corneal decompensation in both patients, the view past the anterior cornea was negligible using standard microscope illumination techniques. We used spectral-domain (Patient 1) and swept-source (Patient 2) MIOCT, both of which rely on infrared ...

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    18. Handheld, rapidly switchable, anterior/posterior segment swept source optical coherence tomography probe

      Handheld, rapidly switchable, anterior/posterior segment swept source optical coherence tomography probe

      We describe the first handheld, swept source optical coherence tomography (SSOCT) system capable of imaging both the anterior and posterior segments of the eye in rapid succession. A single 2D microelectromechanical systems (MEMS) scanner was utilized for both imaging modes, and the optical paths for each imaging mode were optimized for their respective application using a combination of commercial and custom optics. The system has a working distance of 26.1 mm and a measured axial resolution of 8 μm (in air). In posterior segment mode, the design has a lateral resolution of 9 μm, 7.4 mm imaging depth ...

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    19. Pupil tracking optical coherence tomography for precise control of pupil entry position

      Pupil tracking optical coherence tomography for precise control of pupil entry position

      To maximize the collection efficiency of back-scattered light, and to minimize aberrations and vignetting, the lateral position of the scan pivot of an optical coherence tomography (OCT) retinal scanner should be imaged to the center of the ocular pupil. Additionally, several retinal structures including Henle’s Fiber Layer (HFL) exhibit reflectivities that depend on illumination angle, which can be controlled by varying the pupil entry position of the OCT beam. In this work, we describe an automated method for controlling the lateral pupil entry position in retinal OCT by utilizing pupil tracking in conjunction with a 2D fast steering mirror ...

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    20. Novel microscope-integrated stereoscopic display for intrasurgical optical coherence tomography

      Novel microscope-integrated stereoscopic display for intrasurgical optical coherence tomography

      The first generation of intrasurgical optical coherence tomography (OCT) systems displayed OCT data onto a separate computer monitor, requiring surgeons to look away from the surgical microscope. In order to provide real-time OCT feedback without requiring surgeons to look away during surgeries, recent prototype research and commercial intrasurgical OCT systems have integrated heads-up display (HUD) systems into the surgical microscopes to allow the surgeons to access the OCT data and the surgical field through the oculars concurrently. However, all current intrasurgical OCT systems with a HUD are only capable of imaging through one ocular limiting the surgeon’s depth perception ...

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    1-22 of 22
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    1. (22 articles) Duke University
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    Novel microscope-integrated stereoscopic display for intrasurgical optical coherence tomography Handheld, rapidly switchable, anterior/posterior segment swept source optical coherence tomography probe 4D microscope-integrated OCT improves accuracy of ophthalmic surgical maneuvers Novel microscope-integrated stereoscopic heads-up display for intrasurgical optical coherence tomography Pupil Tracking for Real-Time Motion Corrected Anterior Segment Optical Coherence Tomography Needle Depth and Big-Bubble Success in Deep Anterior Lamellar Keratoplasty: An Ex Vivo Microscope-Integrated OCT Study Intraoperative 4-Dimensional Microscope-Integrated Optical Coherence TomographyGuided 27-Gauge Transvitreal Choroidal Biopsy for Choroidal Melanoma Microscope-Integrated Optical Coherence Tomography Angiography in the Operating Room in Young Children With Retinal Vascular Disease Real-time visualization and interaction with static and live optical coherence tomography volumes in immersive virtual reality Feature of the Week 06/24/2018: Duke University Researchers Show Exciting Advances in Live OCT Volumes in Immersive Virtual Reality Duke University Engineering Professor Sina Farsiu Elected Fellow of the IEEE PhotoniCare Takes First Place at the 2019 HealthTECH Startup Competition