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Title: Optical coherence tomography (OCT) – guided ophthalmic therapy
Abstract: Optical coherence tomography (OCT), which provides cross-sectional images noninvasively with a micro-scale in real-time, has been widely applied for the diagnosis and treatment guidance for ocular diseases.
Selective retina therapy (SRT) is an effective laser treatment method for retinal diseases associated with a degradation of the retinal pigment epithelium (RPE). The SRT selectively targets the RPE, so it reduces negative side effects and facilitates healing of the induced retinal lesions. However, the selection of proper laser energy is challenging because of ophthalmoscopically invisible lesions in the RPE and variance in melanin concentration between patients and even between regions within an eye. In the first part of this work, we propose and demonstrate SRT monitoring and temperature estimation based on speckle variance OCT (svOCT) for dosimetry control. SvOCT quantifies speckle pattern variation caused by moving particles or structural changes in biological tissues. We find that the svOCT peak values have a reliable correlation with the degree of retinal lesion formation. The temperature at the neural retina and RPE is estimated from the svOCT peak values using numerically calculated temperature, which is consistent with the observed lesion creation.
In the second part, we propose to develop a hand-held subretinal-injector actively guided by a common-path OCT (CP-OCT) distal sensor. Subretinal injection delivers drug or stem cells in the space between RPE and photoreceptor layers, so it can directly affect resident cell and tissues in the subretinal space. The technique requires high stability and dexterity of surgeon due to fine anatomy of the retina, and it is challenging because of physiological motions of surgeons like hand tremor. We mainly focus on two aspects of the CP-OCT guided subretinal-injector: (i) A high-performance fiber probe based on high index epoxy lensed-fiber to enhance the CP-OCT retinal image quality in a wet environment; (ii) Automated layer identification and tracking: Each retinal layer boundary, as well as retinal surface, is tracked using convolutional neural network (CNN)-based segmentation for accurate localization of a needle. The CNN performing retinal layer segmentation is integrated into the CP-OCT system for targeted layer distance sensing, and the CP-OCT distal sensor guided system is tested on ex vivo bovine retina.