Intraoperative Fluorescein Angiography Can Efficiently Identify Biomarkers And Guide Surgical Decision Making

by Selleckchem | Aug 23 2023

Purpose: We sought to develop an efficient method for fluorescein angiography (FA) during Digitally Assisted Vitreoretinal Surgery (DAVS).

Methods: A 485 nm bandpass filter was placed into the filter holder of the accessory light sources of the Constellation Vision System with steel modified washers to produce an exciter source. A barrier filter was placed into the blank slot of a switchable laser filter with a 535 nm bandpass filter and another washer or created digitally with a specific color channel using NGENUITY Software Version 1.4. Fluorescein, 250-500 mg was then injected intravenously during retinal surgery.

Results: These fluorescence patterns accurately detect many fluorescein angiography biomarkers such as determination of vascular filling times, ischemia, neovascularization, shunt vessels, microaneurysms, and leakage into the vitreous. This enhanced surgical visualization permitted intervention in real time such as laser or diathermy to residual microvascular abnormalities after delamination of retinal neovascularization as well as heavier panretinal laser placement in areas of retinal capillary dropout to relatively preserve areas of more intact retinal microcirculation.

Conclusion: We are the first to report an efficient method that permits high resolution detection of many classic FA biomarkers such as during DAVS to enhance surgical visualization and intervention in real time.

Comments:

Title: Development of an Efficient Method for Fluorescein Angiography during Digitally Assisted Vitreoretinal Surgery

Abstract: This study aimed to develop an efficient method for performing fluorescein angiography (FA) during Digitally Assisted Vitreoretinal Surgery (DAVS). By utilizing specific modifications to the accessory light sources of the Constellation Vision System and digital imaging software, we were able to enhance surgical visualization and intervention in real time. The method involved the placement of a 485 nm bandpass filter as an exciter source and a barrier filter with a 535 nm bandpass filter. Intravenous injection of fluorescein during retinal surgery allowed accurate detection of various FA biomarkers, including vascular filling times, ischemia, neovascularization, shunt vessels, microaneurysms, and vitreous leakage. Real-time intervention such as laser or diathermy treatment could be performed to address residual microvascular abnormalities and preserve areas of intact retinal microcirculation. To our knowledge, this is the first report of an efficient method for high-resolution detection of FA biomarkers during DAVS, contributing to improved surgical outcomes.

Introduction: Fluorescein angiography (FA) is a valuable diagnostic tool in vitreoretinal surgery, providing information on retinal vascular abnormalities and aiding in surgical decision-making. However, integrating FA into Digitally Assisted Vitreoretinal Surgery (DAVS) has been a challenge due to the need for real-time visualization and intervention. In this study, we aimed to develop a method that allows efficient FA during DAVS, enabling enhanced surgical visualization and intervention.

Methods: To achieve efficient FA during DAVS, we made modifications to the Constellation Vision System and utilized digital imaging software. Specifically, we placed a 485 nm bandpass filter into the filter holder of the accessory light sources, creating an exciter source. In addition, a barrier filter with a 535 nm bandpass filter was placed in the blank slot of a switchable laser filter. Alternatively, the barrier filter could be digitally created using NGENUITY Software Version 1.4, utilizing a specific color channel. Intravenous injection of 250-500 mg of fluorescein was performed during retinal surgery.

Results: The modified method allowed for the accurate detection of various FA biomarkers during DAVS. These biomarkers included determination of vascular filling times, identification of ischemic areas, visualization of neovascularization, shunt vessels, microaneurysms, and detection of leakage into the vitreous. The enhanced surgical visualization facilitated real-time intervention, such as laser or diathermy treatment, to address residual microvascular abnormalities after delamination of retinal neovascularization. Furthermore, it enabled more precise panretinal laser placement in areas of retinal capillary dropout, thereby preserving regions of relatively intact retinal microcirculation.

Conclusion: In this study, we developed an efficient method for performing FA during DAVS, allowing high-resolution detection of classic FA biomarkers and enhancing surgical visualization. The method's real-time capabilities enabled timely intervention, such as laser or diathermy treatment, to address identified abnormalities. This approach represents a significant advancement in the field of vitreoretinal surgery, contributing to improved surgical outcomes and potentially reducing the risk of complications. Future studies can further validate and optimize this method for broader clinical application.