Optimising deep anterior lamellar keratoplasty (DALK) using intraoperative online optical coherence tomography (iOCT).

BACKGROUND/AIMS: To describe the use of intraoperative online optical coherence tomography (iOCT) for improving deep anterior lamellar keratoplasty (DALK) surgery. METHODS: Retrospective case series of 6 eyes of 6 male patients with keratokonus, corneal dystrophy or herpetic stromal scars undergoing DALK were investigated using intraoperative optical coherence tomography and postsurgical image/video analysis. Main outcome measures were: visibility of surgical steps, especially, assessment of placement depth of injection needle, preparation of bare Descemet's membrane and drainage of interface fluid. RESULTS: iOCT enables real-time visualisation of all surgical steps of DALK procedure in all patients. Placement of air injection needle above Descemet's membrane was reliably monitored as was presence of bare Descemet's membrane and potential interface fluid. CONCLUSIONS: iOCT assists with visualisation of injection needle placement and with assessment of bare Descemet's membrane as well as interface fluid during the DALK procedure. Overall iOCT may be a helpful device that supports surgeons in all steps of DALK procedure.

Two-photon microscopy and fluorescence lifetime imaging of retinal pigment epithelial cells under oxidative stress.

PURPOSE: The aim of this study was to investigate the autofluorescence (AF) of the RPE with two-photon microscopy (TPM) and fluorescence lifetime imaging (FLIM) under normal and oxidative stress conditions. METHODS: Porcine RPE-choroid explants were used for investigation. The RPE-choroid tissue was preserved in a perfusion organ culture system. Oxidative stress was induced by laser photocoagulation with frequency-doubled ND:YAG laser (532 nm) and by exposure to different concentrations (0, 1, 10 mM) of ferrous sulfate (FeSO4) for 1 hour. At indicated time points after exposure, the tissue was examined with TPM and FLIM. Intracellular reactive oxygen species around the photocoagulation lesion were detected with chloromethyl-2'7'-dichlorofluorescein diacetate (CM-H2DCFDA). Melanosomes were isolated from RPE cells and their fluorescence properties were investigated under normal and oxidized conditions. RESULTS: Under normal conditions, AF in RPE cells with TPM is mostly originated from melanosomes, which has a very short fluorescence lifetime (FLT; mean = 117 ps). Under oxidative stress induced by laser irradiation and FeSO4 exposure, bright granular AF appears inside and around RPE cells, whose FLT is significantly longer (mean = 1388 ps) than the FLT of the melanosome-AF. Excitation and emission peaks are found at 710 to 750 nm and 450 to 500 nm, respectively. Oxidative stress increases the fluorescence intensity of the melanosomes but does not change their FLT. CONCLUSIONS: TPM reveals acute oxidative stress-induced bright AF granules inside and around RPE cells which can be clearly discriminated from melanosomes by FLIM. TPM combined with FLIM is a useful tool of live-cell analysis to investigate functional alterations of the RPE.

Two-photon fluorescence lifetime imaging monitors metabolic changes during wound healing of corneal epithelial cells in vitro.

BACKGROUND: Early and correct diagnosis of delayed or absent corneal epithelial wound healing is a key factor in the prevention of infection and consecutive destruction of the corneal stroma with impending irreversible visual loss. Two-photon microscopy (TPM) is a novel technology that has potential to depict epithelial cells and to evaluate cellular function by measuring autofluorescence properties such as fluorescence intensity and fluorescence lifetimes of metabolic co-factors such as NAD(P)H. METHODS: Using non-invasive TPM in a tissue-culture scratch model and an organ-culture erosion model, fluorescence intensity and fluorescence lifetimes of NAD(P)H were measured before and during closure of the epithelial wounds. Influence of temperature and selective inhibition of metabolism on intensity and lifetimes were tested additionally. RESULTS: Decrease of temperature resulted in significant increase of fluorescence lifetimes and decrease of the relative amount of free NAD(P)H due to decreased global metabolism. Increase in temperature and upregulation of glycolysis through blocking the mitochondrial electron transport chain by rotenone resulted in increased intensity, decreased lifetimes and increase in the relative amount of free NAD(P)H. Changes of lifetimes and free:protein-bound NAD(P)H ratios were similar to changes measured during wound healing in both scratch and erosion models. CONCLUSIONS: Fluorescence lifetime measurements (FLIM) detected enhancement of cellular metabolism following epithelial damage in both models. The prospective detection of cellular autofluorescence in vivo, in particular FLIM of metabolic cofactor NAD(P)H, has the potential to become an indispensible tool in clinical use to differentiate healing from non-healing epithelial cells and to evaluate effects of newly developed substances on cellular metabolism in preclinical and clinical trials.

Complex morphology and functional dynamics of vital murine intestinal mucosa revealed by autofluorescence 2-photon microscopy.

The mucosa of the gastrointestinal tract is a dynamic tissue composed of numerous cell types with complex cellular functions. Study of the vital intestinal mucosa has been hampered by lack of suitable model systems. We here present a novel animal model that enables highly resolved three-dimensional imaging of the vital murine intestine in anaesthetized mice. Using intravital autofluorescence 2-photon (A2P) microscopy we studied the choreographed interactions of enterocytes, goblet cells, enteroendocrine cells and brush cells with other cellular constituents of the small intestinal mucosa over several hours at a subcellular resolution and in three dimensions. Vigorously moving lymphoid cells and their interaction with constituent parts of the lamina propria were examined and quantitatively analyzed. Nuclear and lectin staining permitted simultaneous characterization of autofluorescence and admitted dyes and yielded additional spectral information that is crucial to the interpretation of the complex intestinal mucosa. This novel intravital approach provides detailed insights into the physiology of the small intestine and especially opens a new window for investigating cellular dynamics under nearly physiological conditions.

[Diagnosis of the deep partial-thickness burn wound of Skh-1 mouse with Optical Coherence Tomography].

OBJECTIVE: To evaluate the application value of Optical Coherence Tomography (OCT) in the diagnosis of the depth of burn wound. METHODS: Deep partial-thickness scald models of Skh-1 mice were reproduced using self-made steam scald appliance. The scald wounds were scanned with OCT 3 hours, or 3 and 8 days after injury respectively. Scanned wound tissue was harvested for histological examination right after each episode of OCT imaging. Normal skin of mice was scanned and examined with the above-mentioned methods at the same time. RESULTS: Compared with those of the normal skin, collagen in the dermis was denatured after steam scald, and it was imaged as vanishing or reduction in birefringence in OCT detection. The structure change intensity was related to the pathological process of the wounds and consistent with the corresponding histological results. CONCLUSIONS: OCT is a noninvasive technique. It can be used to diagnose the depth of burn wound in real time.

Automated segmentation of tissue structures in optical coherence tomography data.

Segmentation of optical coherence tomography (OCT) images provides useful information, especially in medical imaging applications. Because OCT images are subject to speckle noise, the identification of structures is complicated. Addressing this issue, two methods for the automated segmentation of arbitrary structures in OCT images are proposed. The methods perform a seeded region growing, applying a model-based analysis of OCT A-scans for the seed's acquisition. The segmentation therefore avoids any user-intervention dependency. The first region-growing algorithm uses an adaptive neighborhood homogeneity criterion based on a model of an OCT intensity course in tissue and a model of speckle noise corruption. It can be applied to an unfiltered OCT image. The second performs region growing on a filtered OCT image applying the local median as a measure for homogeneity in the region. Performance is compared through the quantitative evaluation of artificial data, showing the capabilities of both in terms of structures detected and leakage. The proposed methods were tested on real OCT data in different scenarios and showed promising results for their application in OCT imaging.

RPE damage thresholds and mechanisms for laser exposure in the microsecond-to-millisecond time regimen.

PURPOSE: The retinal pigment epithelium (RPE) cells with their strongly absorbant melanosomes form the highest light-absorbing layer of the retina. It is well known that laser-induced retinal damage is caused by thermal denaturation at pulse durations longer than milliseconds and by microbubble formation around the melanosomes at pulses shorter than microseconds. The purpose of this work was to determine the pulse width when both effects merge. Therefore, the RPE damage threshold and mechanism of the damage at single laser pulses of 5-micros to 3-ms duration were investigated. METHODS: An argon laser beam (lambda 514 nm) was externally switched by an acousto-optic modulator to achieve pulses with constant power in the time range of 5 micros up to 3 ms. The pulses were applied to freshly prepared porcine RPE samples serving as a model system. After laser exposure RPE cell damage was proved by the cell-viability stain calceinAM. Microbubble formation was detected by acoustic techniques and by reflectometry. RESULTS: At a pulse duration of 5 micros, RPE cell damage was always associated with microbubble formation. At pulses of 50 micros, mostly thermal denaturation, but also microbubble formation, was detected. At the longer laser pulses (500 micros, 3 ms), RPE cell damage occurred without any microbubble appearance. CONCLUSIONS: At threshold irradiance, the transition time from thermal denaturation to thermomechanical damage of RPE cells is slightly below the laser pulse duration of 50 micros.