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Surgical interventions for ocular diseases involve manipulations of semi-transparent structures in the eye, but limited
visualization of these tissue layers remains a critical barrier to developing novel surgical techniques and improving clinical
outcomes. We addressed limitations in image-guided ophthalmic microsurgery by using microscope-integrated
multimodal intraoperative swept-source spectrally encoded scanning laser ophthalmoscopy and optical coherence
tomography (iSS-SESLO-OCT). We previously demonstrated in vivo human ophthalmic imaging using SS-SESLO-OCT,
which enabled simultaneous acquisition of en face SESLO images with every OCT cross-section. Here, we integrated our
new 400 kHz iSS-SESLO-OCT, which used a buffered Axsun 1060 nm swept-source, with a surgical microscope and
TrueVision stereoscopic viewing system to provide image-based feedback. In vivo human imaging performance was
demonstrated on a healthy volunteer, and simulated surgical maneuvers were performed in ex vivo porcine eyes. Denselysampled
static volumes and volumes subsampled at 10 volumes-per-second were used to visualize tissue deformations and
surgical dynamics during corneal sweeps, compressions, and dissections, and retinal sweeps, compressions, and elevations.
En face SESLO images enabled orientation and co-registration with the widefield surgical microscope view while OCT
imaging enabled depth-resolved visualization of surgical instrument positions relative to anatomic structures-of-interest.
TrueVision heads-up display allowed for side-by-side viewing of the surgical field with SESLO and OCT previews for
real-time feedback, and we demonstrated novel integrated segmentation overlays for augmented-reality surgical guidance.
Integration of these complementary imaging modalities may benefit surgical outcomes by enabling real-time intraoperative
visualization of surgical plans, instrument positions, tissue deformations, and image-based surrogate biomarkers correlated
with completion of surgical goals.
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