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Depth-Based, Motion-Stabilized Colorization of Microscope-Integrated Optical Coherence Tomography Volumes for Microscope-Independent Microsurgery.

Purpose: We develop and assess the impact of depth-based, motion-stabilized colorization (color) of microscope-integrated optical coherence tomography (MIOCT) volumes on microsurgical performance and ability to interpret surgical volumes.

Methods: Color was applied in real-time as gradients indicating axial position and stabilized based on calculated center of mass. In a test comparing colorization versus grayscale visualizations of prerecorded intraoperative volumes from human surgery, ophthalmologists ( N = 7) were asked to identify retinal membranes, the presence of an instrument, its contact with tissue, and associated deformation of the retina. In a separate controlled trial, trainees ( N = 15) performed microsurgical skills without conventional optical visualization and compared colorized versus grayscale MIOCT visualization on a stereoptic screen. Skills included thickness identification, instrument placement, and object manipulation, and were assessed based on time, performance metrics, and confidence.

Results: In intraoperative volume testing, colorization improved ability to differentiate membrane from retina ( P < 0.01), correctly identify instrument contact with membrane ( P = 0.03), and retinal deformation ( P = 0.01). In model microsurgical skills testing, trainees working with colorized volumes were faster ( P < 0.01) and more correct ( P < 0.01) in assessments of thickness for recessed and elevated objects, were less likely to inadvertently contact a surface when approaching with an instrument ( P < 0.01), and uniformly more confident ( P < 0.01 for each) in conducting each skill.

Conclusions: Depth-based colorization enables effective identification of retinal membranes and tissue deformation. In microsurgical skill testing, it improves user efficiency, and confidence in microscope-independent, OCT-guided model surgical maneuvers.

Translational Relevance: Novel depth-based colorization and stabilization technology improves the use of intraoperative MIOCT.

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