Microscope-Integrated Intraoperative Optical Coherence Tomography For Examination Of Infants Under Sedation

Infants are often unable to cooperate with fixation and high-quality clear OCT imaging is difficult to obtain in a clinical setting. Therefore, general anesthesia (GA) is required for the diagnosis and follow-up of ophthalmological conditions in these patients. The aim of this study was to evaluate whether the utilization of microscope-integrated intraoperative optical coherence tomography (MI-OCT) under sedation in infants with anterior or posterior disorders could be a safe alternative to GA without affecting the OCT signal intensity and quality.

Ophthalmology Unit, S. Anna University Hospital, Ferrara, Italy

Sedation was achieved by means of target-controlled infusion of propofol 1% maintaining spontaneous breathing. OCT imaging was obtained with a spectral-domain OCT system (RESCAN 700, Carl Zeiss Meditec, Germany) integrated into the OPMI Lumera 700 microscope (Carl Zeiss Meditec, Germany). After focusing on the anterior segment, intraoperative OCT images of the cornea, lens and retrolental space were acquired. For posterior imaging, the Resight viewing system was employed, and OCT scans of the posterior pole were acquired.

6 patients (3 male, 3 females) with a mean age of 7.7 ± 3.3 months were enrolled in the study. Indications for examination were altered red-reflex in 4 patients, follow-up after mushroom keratoplasty (MK) for Peters’ anomaly in 2 patients. In the 2 transplanted patients imaging demonstrated anterior synechiae, with both graft-host junction and peripheral synechiae. In 1 patients with altered red-reflex, MI-OCT revealed focal defect of Descemet’s membrane and endothelium, anterior synechiae, absent anterior chamber; a diagnosis of Peters’ anomaly was made. In the last 3 patients MI-OCT showed web-like fibrous bands attached to the posterior lens capsule and peripapillary vitreoretinal traction. Persistent fetal vasculature was diagnosed. 

Routine imaging with microscope-mounted OCT during sedation allows the visualization of the anterior and posterior segment in uncooperative infants without the need for GA. The ability to acquire high-resolution spectral-domain OCT images using a microscope-integrated device in sedated infants ultimately may improve the diagnostic process, preoperative surgical planning, follow-up, assessment of treatment response and family counselling of infants with eye anomalies. Repeated imaging sessions under sedation represent a safe and valuable instrument to follow-up infants with anterior or posterior disorders.