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光学相干层析技术在眼科手术导航方面的研究进展

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文章导航 > 光电工程 > 2023 Vol. 50 > No. 1 > 220027

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李云耀，樊金宇，蒋天亮，等. 光学相干层析技术在眼科手术导航方面的研究进展[J]. 光电工程，2023，50(1): 220027. doi: 10.12086/oee.2023.220027
引用本文: 李云耀，樊金宇，蒋天亮，等. 光学相干层析技术在眼科手术导航方面的研究进展[J]. 光电工程，2023，50(1): 220027. doi: 10.12086/oee.2023.220027
shu
Li Y Y, Fan J Y, Jiang T L, et al. Review of the development of optical coherence tomography imaging navigation technology in ophthalmic surgery[J]. Opto-Electron Eng, 2023, 50(1): 220027. doi: 10.12086/oee.2023.220027
Citation: Li Y Y, Fan J Y, Jiang T L, et al. Review of the development of optical coherence tomography imaging navigation technology in ophthalmic surgery[J]. Opto-Electron Eng, 2023, 50(1): 220027. doi: 10.12086/oee.2023.220027
shu

光学相干层析技术在眼科手术导航方面的研究进展

    • 1.

      中国科学技术大学，安徽 合肥 230026

    • 2.

      中国科学院苏州生物医学工程技术研究所，江苏 苏州 215163

  • 基金项目:
    国家重点研发计划(2022YFC2400771)；江苏省科技计划项目(BK20220263)
详细信息
    作者简介:
  • 李云耀(1998-)，男，博士研究生，研究方向为眼科手术机器人。E-mail: lyy980602@mail.ustc.edu.cn;
  • 史国华(1981-)，男，博士，研究员，研究方向为光学成像。E-mail: ghshi_lab@126.com
    • 通讯作者: 史国华，ghshi_lab@126.com

  • 中图分类号: TN247

Review of the development of optical coherence tomography imaging navigation technology in ophthalmic surgery

    • 1.

      Department of Biomedical Engineering, University of Science and Technology of China, Hefei, Anhui 230026, China

    • 2.

      Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology Chinese Academy of Sciences, Suzhou, Jiangsu 215163, China

  • Fund Project: National Key R&D Program of China Fund (2022YFC2400771), and Jiangsu Science and Technology Plan Program Fund (BK20220263)
More Information

    摘要

  • 在眼科显微手术中，传统的术中成像方式由于缺少深度信息，限制了内部结构和手术器械的可视化。光学相干层析成像技术(OCT)是一种非接触式断层成像技术，由于其能提供深度信息、非侵入、成像快、分辨率高等优点，被广泛应用于眼科手术的术中导航。典型的OCT设备可分为手持OCT和显微镜集成OCT。本文简要介绍了时域OCT和频域OCT的原理和发展，回顾了OCT眼科手术导航设备的发展历程，并对各个类别中有代表性的OCT系统进行了介绍，对其成像原理、性能、优缺点等进行了描述和对比，最后对该技术在眼科手术中的应用做出了总结和展望。

    During ophthalmic microsurgery, the visualization of internal structures is limited by traditional intraoperative imaging methods due to their lack of depth information. Optical coherence tomography (OCT) is a non-contact tomographic imaging technique that is widely used for intraoperative navigation in ophthalmic surgery because of its ability to provide depth information, non-invasiveness, fast imaging, and high resolution. Typical OCT devices can be divided into handheld OCT and microscope-integrated OCT. This article briefly introduces the mechanism and development of time domain OCT and fourier domain OCT, reviews the development of OCT ophthalmic surgical navigation devices, introduces representative OCT systems in each category, describes and compares their imaging principles, performance, advantages, and disadvantages, and finally concludes with a summary and outlook on the applications of this technology in ophthalmic surgery.

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  • 图 1  时域OCT系统示意图。SLD：低相干光源；FOC：光纤耦合器；PC：偏振调制器；PM：相位调制器；D：光电探测器；DM：解调器

    Figure 1.  System schematic of the TD-OCT system. SLD: super luminescent diode; FOC: fiber optic couplers; PC: polarization modulators; PM: phase modulator; D: detector; DM: demodulator

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    图 2  Boppart等研发的HHOCT探头[39]。(a) HHOCT探头结构；(b) 使用HHOCT探头扫描眼部；(c) 角膜的实时OCT成像

    Figure 2.  HHOCT probes developed by Boppart et al[39]. (a) The structure of the HHOCT probe; (b) Eye scan using HHOCT probe; (c) Real-time OCT imaging of the cornea

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    图 3  二维MEMS扫描镜[50]。(a) 扫描示意图；(b) 封装后的MEMS扫描镜

    Figure 3.  Two dimensional MEMS scanning mirror[50]. (a) Layout of the scanning system; (b) Packaged MEMS scanning mirror

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    图 4  Lu等研发的HHOCT探头[42]。(a, b)探头外观及结构；(c) 使用HHOCT得到的眼底黄斑区图像

    Figure 4.  HHOCT probes developed by Lu et al[42]. (a, b) The probe and its structure; (c) HHOCT imaging of the macula

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    图 5  HHOCT探针。(a-c) Joos等设计的25G手持OCT探针[57]；(d-f) Asami等设计的23G手持OCT探针[56]

    Figure 5.  Needle-based HHOCT probes. (a-c) 25G needle-based fiber HHOCT probe designed by Joos et al[57]; (d-f) 23G needle-based fiber HHOCT probe designed by Asami et al[56]

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    图 6  集成OCT的手术器械。(a) SMART微型手术钳[58]；(b, c) Yu等设计的OCT集成手术钳[61]；(d) 使用OCT集成手术钳接近离体山羊眼视网膜[61]

    Figure 6.  OCT-integrated surgical instruments. (a) SMART micro forceps[58]; (b, c) OCT-integrated micro forceps designed by Yu et al[61]; (d) Approaching goat retinal using OCT-integrated micro forceps[61]

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    图 7  研究阶段MIOCT设备。(a) 在显微镜相机端口集成的MIOCT[64]；(b, c) 显微镜物镜前集成的MIOCT[68]

    Figure 7.  Research-grade MIOCT systems. (a) MIOCT scanner coupled onto the camera port of a microscope[64]; (b, c) MIOCT integrated prior to the objective[68]

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    图 8  商业化MIOCT：蔡司RESCAN 700。(a) RESCAN 700机体[3]；(b) 医生在手术中使用RESCAN 700[69]；(c) RESCAN 700光学显微镜眼底成像[68]；(d) RESCAN 700 OCT系统眼底成像[71]

    Figure 8.  Commercialized MIOCT system: Zeiss RESCAN 700. (a) RESCAN 700 system[3]; (b) Surgeon using RESCAN 700 during ocular surgeries[69]; (c) Microscope imaging of the RESCAN 700 system[68]; (d) OCT imaging of the RESCAN 700 system[71]

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    图 9  使用MIOCT进行术中实时2D成像。(a) 使用单个B扫描对视网膜成像[71]；(b) 使用正交B扫描对角膜成像[73]；(c) 使用5束平行B扫描对视网膜成像[69]

    Figure 9.  Intrasurgical live 2D imaging with MIOCT. (a) Retinal imaging using single B-scan[71]; (b) Corneal imaging using two orthogonal B-scans[73]; (c) Retinal imaging using 5 parallel B-scans[69]

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    图 10  使用基于扫频OCT的MIOCT对眼前节手术(泪道成形术)成像[78]。(a, b) 切开浅层巩膜瓣后的MIOCT图像；(c, d) 插入小梁切刀后的MIOCT图像；(e, f) 借助MIOCT图像确认集束管扩张

    Figure 10.  Real-time images of anterior segment surgery(canaloplasty) from the microscope-integrated swept-source optical coherence tomography (MIOCT) system[78]. (a, b) MIOCT image after incision of a superficial scleral flap; (c, d) MIOCT image after insertion of a custom-made trabeculotomy; (e, f) Confirming expansion of the collector vessel using MIOCT image

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    图 11  使用基于扫频OCT的MIOCT导航眼科手术操作的实验结果[77]。(a) 术中OCT成像；(b) 术后OCT切口分析；(c) 精度测试结果。Trial 1：使用(+)和未使用(－)MIOCT的对比；Trial 2：经MIOCT训练(+/－)和未经MIOCT训练(－/－)后使用传统显微镜的手术精度对比(*代表统计学显著不同)

    Figure 11.  Experimental results of ophthalmic surgeries navigated by swept-frequency OCT-based MIOCT. (a) Intraoperative OCT image; (b) Postoperative suture analysis using OCT; (c) Accuracy test results. Trial 1: comparison of the results with (+) and without (-) MIOCT; Trial 2: accuracy of traditional microscope guided surgeries with (+/－) and without (－/－) MIOCT training (* represents statistically significant difference)

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    图 12  4D MIOCT实时成像。(a) 观测视网膜上的陶瓷球体[82]；(b) 手术工具抓取视网膜色素上皮细胞层的实时图像[83]；(c) 玻璃体切除术中视网膜下积液的二维和三维图像[84]

    Figure 12.  4D MIOCT real-time imaging. (a) Observing a ceramic ball on the retina[82]; (b) Real-time image of a surgical tool grasping the retinal pigment epithelial cell layer[83]; (c) 2D and 3D images of subretinal fluid during vitrectomy[84]

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    图 13  可实现三维可视化的HUD集成MIOCT[79]。(a) 医生在手术中使用带有HUD的MIOCT系统；(b) 左右目镜中的实时图像

    Figure 13.  HUD-integrated MIOCT for 3D visualization[79]. (a) HUD-integrated MIOCT in use during a surgery; (b) Real-time image displayed on both oculars

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    图 14  使用体积增强渲染算法处理MIOCT图像[81]。(a) 渲染前的人眼MIOCT图像；(b) 增强渲染后的人眼MIOCT图像；(c) 原始视网膜(Epiretinal membrane, ERM)及黄斑孔(macular hole, MH)MIOCT图像；(d) 增强渲染后的视网膜及黄斑孔MIOCT图像

    Figure 14.  MIOCT images with enhanced volume rendering[81]. (a) Original MIOCT image of human eye; (b) Enhanced MIOCT image of human eye; (c) Original MIOCT image of an epiretinal membrane (ERM) and a macular hole (MH); (d) Enhanced MIOCT image of an epiretinal membrane (ERM) and a macular hole (MH)

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    图 15  视网膜剥离术中的MIOCT图像及其着色[87]。(a) 术中MIOCT图像；(b) 着色后的MIOCT图像

    Figure 15.  Original and colorized MIOCT images of retinal membrane peeling[87]. (a) Intraoperative MIOCT image; (b) Colorized MIOCT image

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收稿日期:  2022-03-28
修回日期:  2022-10-17
录用日期:  2022-10-21
网络出版日期:  2022-12-22
刊出日期:  2023-01-25

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