Methods and Systems for OCT Guided Glaucoma Surgery

Abstract

Disclosed herein are systems and methods for aiding a surgeon to perform a surgical procedure on an eye. The surgical procedure includes inserting an elongate probe from an opening into the eye across an anterior chamber to a target tissue region comprising a trabecular meshwork and a Schlemm's canal. Exemplary systems include an optical microscope for the surgeon to view the eye with a microscope image during the procedure; an optical coherence tomography (OCT) apparatus configured to perform an OCT scan of a target location in the target tissue region during the procedure; and an image processing apparatus configured to generate an augmented image by overlaying an OCT image of target location and a graphical visual element identifying the locations, wherein the graphical visual element is registered with the microscope image to aid the surgeon in advancing a distal end of the elongate probe to the target location.

What is claimed is: 
     
         1 . A system for aiding a physician to perform a surgical procedure on an eye of a patient, wherein the procedure comprises inserting an elongate probe from an opening into the eye across an anterior chamber to a target tissue region of the eye, the target tissue region comprising a Schlemm's canal and a trabecular meshwork, the system comprising:
 an optical microscope;   an optical coherence tomographer; and   an image processing apparatus comprising a processor, an electronic storage location operatively coupled with the processor, and processor executable code stored on the electronic storage location and embodied in a tangible non-transitory computer readable medium, the processor executable code comprising machine-readable instructions that, when executed by the processor, cause the processor to generate an augmented microscope view of the eye, the augmented microscope view comprising:
 a microscope image of the eye obtained by the optical microscope, the microscope image corresponding to an x-y plane of the eye, the trabecular meshwork of the target tissue region not visible in the microscope image due to total internal reflection of the trabecular meshwork of the target tissue region, 
 a computer generated image of the target tissue region of the eye, the computer generated image based on optical coherence tomography data obtained by the optical coherence tomographer, the computer generated image corresponding to an anterior-posterior plane of the eye that is perpendicular to the x-y plane of the eye, the computer generated image in registration relative to the microscope image, 
 a graphical visual element overlaid to and in registration with the microscope image, the graphical visual element mapped to a radial target location of the target tissue region, the radial target location based on a preoperative optical coherence tomography image or a real-time optical coherence tomography image obtained by the optical coherence tomographer, and 
 a treatment reference marker overlaid to and in registration with the computer generated image, the treatment reference marker mapped to an anterior-posterior depth target location of the target tissue region and to the radial target location of the target tissue region, the anterior-posterior depth target location corresponding to the Schlemm's canal, 
 the graphical visual element aiding the physician in advancing a distal end of the elongate probe to the radial target location and the treatment reference marker aiding the physician in advancing the distal end of the elongate probe to the anterior-posterior depth target location. 
   
     
     
         2 . The system of  claim 1 , wherein the optical coherence tomographer comprises a microscope-based optical coherence tomographer. 
     
     
         3 . The system of  claim 1 , wherein the optical coherence tomographer comprises a fiberoptic-based optical coherence tomographer. 
     
     
         4 . The system of  claim 1 , wherein the radial target location is based on the preoperative optical coherence tomography image. 
     
     
         5 . The system of  claim 1 , wherein the radial target location is based on the real-time optical coherence tomography image. 
     
     
         6 . The system of  claim 1 , wherein the radial target location corresponds to a collector channel network of the eye. 
     
     
         7 . A method for generating an augmented microscope view of a target tissue region of an eye of a patient, the method comprising:
 obtaining a microscope image of the eye with an optical microscope, the microscope image corresponding to an x-y plane of the eye, wherein a trabecular meshwork of the target tissue region is not visible in the microscope image due to total internal reflection of the trabecular meshwork of the target tissue region;   obtaining an optical coherence tomography data from the eye with an optical coherence tomographer, the optical coherence tomography data corresponding to an anterior-posterior plane of the eye that is perpendicular to the x-y plane of the eye; and   generating the augmented microscope view with an image processing apparatus, the image processing apparatus comprising a processor, an electronic storage location operatively coupled with the processor, and processor executable code stored on the electronic storage location and embodied in a tangible non-transitory computer readable medium, the processor executable code comprising machine-readable instructions that, when executed by the processor, cause the processor to generate the augmented microscope view of the eye, the augmented microscope view comprising:
 the microscope image of the eye obtained by the optical microscope, 
 a computer generated image of the eye based on the optical coherence tomography data from the eye obtained by the optical coherence tomographer, wherein the computer generated image of the eye based on the optical coherence tomography data is in registration relative to the microscope image, 
 a graphical visual element overlaid to and in registration with the microscope image, the graphical visual element mapped to a radial target location of the target tissue region, the radial target location based on a preoperative optical coherence tomography image or a real-time optical coherence tomography image obtained by the optical coherence tomographer, and 
 a treatment reference marker overlaid to and in registration with the computer generated image, the treatment reference marker mapped to an anterior-posterior depth target location of the target tissue region and to the radial target location of the target tissue region, the anterior-posterior depth target location corresponding to a Schlemm's canal of the target tissue region. 
   
     
     
         8 . The method of  claim 7 , wherein the optical coherence tomographer comprises a microscope-based optical coherence tomographer. 
     
     
         9 . The method of  claim 7 , wherein the optical coherence tomographer comprises a fiberoptic-based optical coherence tomographer. 
     
     
         10 . The method of  claim 7 , wherein the radial target location is based on the preoperative optical coherence tomography image. 
     
     
         11 . The method of  claim 7 , wherein the radial target location is based on the real-time optical coherence tomography image. 
     
     
         12 . The method of  claim 7 , wherein the radial target location corresponds to a collector channel network of the eye. 
     
     
         13 . A computer system to generate an augmented microscope view of a target tissue region of an eye of a patient, the computer system comprising:
 a processor;   an electronic storage location operatively coupled with the processor; and   processor executable code stored on the electronic storage location and embodied in a tangible non-transitory computer readable medium,   wherein the processor executable code, when executed by the processor, causes the processor to generate the augmented microscope view of the target tissue region of the eye of the patient, the augmented microscope view comprising:   a microscope image of the eye obtained by an optical microscope,   an computer generated image of the eye based on optical coherence tomography data obtained by an optical coherence tomographer,   a graphical visual element overlaid to and in registration with the microscope image, the graphical visual element mapped to a radial target location of the target tissue region, the radial target location based on a preoperative optical coherence tomography image or a real-time optical coherence tomography image obtained by the optical coherence tomographer, and   a treatment reference marker overlaid to and in registration with the computer generated image, the treatment reference marker mapped to an anterior-posterior depth target location of the target tissue region and to the radial target location of the target tissue region, the anterior-posterior depth target location corresponding to a Schlemm's canal of the target tissue region.   
     
     
         14 . The computer system of  claim 13 , wherein the optical coherence tomographer comprises a microscope-based optical coherence tomographer. 
     
     
         15 . The computer system of  claim 13 , wherein the optical coherence tomographer comprises a fiberoptic-based optical coherence tomographer. 
     
     
         16 . The computer system of  claim 13 , wherein the radial target location is based on the preoperative optical coherence tomography image. 
     
     
         17 . The computer system of  claim 13 , wherein the radial target location is based on the real-time optical coherence tomography image. 
     
     
         18 . The computer system of  claim 13 , wherein the radial target location corresponds to a collector channel network of the eye.