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

Question  Is it possible to perform optical coherence tomography angiography in the operating room?

Findings  In this case report of 2 young children with retinal vascular disease who underwent microscope-integrated, intraoperative optical coherence tomography angiography during examination under anesthesia, the microscope-integrated optical coherence tomography angiograms showed more detailed retinal vasculature than was visible in fluorescein angiographic images, especially in areas of previous laser treatment.

Meaning  Intraoperative optical coherence tomography angiography allowed detailed evaluation of retinal vasculature without injection of fluorescein dye in 2 young children who could not cooperate with in-office examinations, suggesting the feasibility of this procedure for similar situations.

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 and a female infant with familial exudative vitreoretinopathy.

Main Outcomes and Measures  Side-by-side comparison of research MIOCT angiograms and clinically indicated fluorescein angiograms.

Results  In 2 young children with retinal vascular disease, the MIOCTA images showed more detailed vascular patterns than were visible on the fluorescein angiograms although within a more posterior field of view. The MIOCTA system allowed visualization of small pathological retinal vessels in the retinal periphery that were obscured in the fluorescein angiograms by fluorescein staining from underlying, preexisting laser scars.

Conclusions and Relevance  This is the first report to date of the use of MIOCTA in the operating room for young children with retinal vascular disease. Further optimization of this system may allow noninvasive detailed evaluation of retinal vasculature during surgical procedures and in patients who could not cooperate with in-office examinations.