A Primary Care Guide to the Screening and Pharmacologic Management of Chronic Kidney Disease in People Living With Type 2 Diabetes.

SIGNIFICANCE: Retinal endolaser photocoagulation is a widely performed vitreoretinal procedure but currently lacks real-time intraoperative feedback on treatment outcomes. Integrating optical coherence tomography (OCT) directly into the endolaser probe enables co-localized, intraoperative sensing of tissue response during laser delivery, offering the potential to significantly enhance surgical safety and efficacy.

AIM: The aim of the study is to design, fabricate, and demonstrate a fiber-optic smart instrument with a 3D nano-printed microlens and instrument-integrated OCT sensing that enables co-localized, concurrent surgical laser delivery and tomographic sensing of tissue alterations during REPC.

APPROACH: A dual-clad fiber was used to co-axially deliver surgical and OCT beams through the outer multi-mode and inner single-mode cores. A 3D nano-printed aspherical microlens ( 300    μ m diameter) at the fiber tip optimized beam shaping for both lasers in the intravitreal cavity. The optical performance of the 23G instrument-integrated OCT (iiOCT) probe was characterized, and ex vivo validation experiments were conducted on porcine eyes.

RESULTS

Optical performance assessments demonstrated close alignment between measured and simulated beam profiles, with an OCT spot size of 37.9    μ m at best focus and a surgical laser beam divergence half-angle of 6.0 deg. The probe demonstrated stable power transmission with a mean deviation of 0.35% across repeated pulses. Ex vivo experiments confirmed co-localized, concurrent surgical laser delivery and OCT sensing of retinal tissue alterations.

CONCLUSIONS

The miniaturized iiOCT endolaser probe combines surgical laser delivery with OCT sensing, achieving adequate performance for the targeted clinical application. This sensor-integrated instrument has the potential to enable intraocular, intraoperative, and quantitative assessment of treatment outcomes. It could support feedback-driven, robotic endolaser photocoagulation, enhancing the safety and efficacy of retinal endolaser surgery.