Optimization Of Laser Scleral Microporation Therapy Utilizing Real Time Interstitial Swept Source Oct & Automated Tissue Segmentation

Scleral rigidity is associated with many ocular conditions, and is therefore important for both research purpose and clinical applications. This study aim was to use Anterior Segment Swept-Source Optical Coherence Tomography (AS-SS-OCT) to image the anterior sclera in vivo over the novel Laser Scleral Microporation treatment (LSM) for scleral uncrosslinking in order to characterize the Microporation patterns and optimize predictive outcomes.

Research was performed in a private independent research project.

Standalone AS-SS-OCT 3D longitudinal and cross sectional measurements were obtained from superior temporal, superior nasal, inferior nasal and inferior temporal quadrants for 40 eyes of 20 Gottingen Minipigs prior to scleral uncrosslnking therapy (LSM). AS-SS-OCT was measured in 1 mm increments starting at the scleral spur over a 7mm distance just proximal to the pars plana.  The on board AS-SS-OCT and adaptive depth control of the Visiolite Er:YAG laser (2.94) was used realtime to execute the microporation pattern of 49 micropores with a spot size of 265um and a depth of 85% scleral thickness.  Measurements were repeated post-LSM to evaluate the microporations depth and pattern.  Pre- and post-treatment images were evaluated.

Pre-treatment AS-SS-OCT measurements and Post-treatment images were evaluated for accuracy of preplanned depth in each micropore showing precision within 10 um for a 265um micropore. There were approximately a 0.2% error rate in microporation patterns. The novel adaptive depth control algorithm was validated by the AS-SS-OCT images both externally and onboard as well as a novel auto tissue segmentation image software. Both pre- and post-LSM images were able to demonstrate the top to bottom measurements of the sclera with image enhancement software.

Scleral microporation depth and pattern was easily evaluated along with confirmation of accuracy of the pre-planned adaptive depth control. AS-SS-OCT was useful in the pre-planning and quantification of Microporation pore volume fraction as well as pattern accuracy verified by post-operative measurements.   The effects of scleral uncrosslinking and other scleral therapies will be  better understood and documented with AS-SS-OCT. This technology also provides great utility for optimizing the LSM procedure accuracy and safety.