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arXiv · 2603.25555

Towards Comprehensive Real-Time Scene Understanding in Ophthalmic Surgery through Multimodal Image Fusion

Nikolo Rohrmoser·Ghazal Ghazaei·Michael Sommersperger·Nassir Navab
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Abstract

Purpose: The integration of multimodal imaging into operating rooms paves the way for comprehensive surgical scene understanding. In ophthalmic surgery, by now, two complementary imaging modalities are available: operating microscope (OPMI) imaging and real-time intraoperative optical coherence tomography (iOCT). This first work toward temporal OPMI and iOCT feature fusion demonstrates the potential of multimodal image processing for multi-head prediction through the example of precise instrument tracking in vitreoretinal surgery. Methods: We propose a multimodal, temporal, real-time capable network architecture to perform joint instrument detection, keypoint localization, and tool-tissue distance estimation. Our network design integrates a cross-attention fusion module to merge OPMI and iOCT image features, which are efficiently extracted via a YoloNAS and a CNN encoder, respectively. Furthermore, a region-based recurrent module leverages temporal coherence. Results: Our experiments demonstrate reliable instrument localization and keypoint detection (95.79% mAP50) and show that the incorporation of iOCT significantly improves tool-tissue distance estimation, while achieving real-time processing rates of 22.5 ms per frame. Especially for close distances to the retina (below 1 mm), the distance estimation accuracy improved from 284 $\mu m$ (OPMI only) to 33 $\mu m$ (multimodal). Conclusion: Feature fusion of multimodal imaging can enhance multi-task prediction accuracy compared to single-modality processing and real-time processing performance can be achieved through tailored network design. While our results demonstrate the potential of multi-modal processing for image-guided vitreoretinal surgery, they also underline key challenges that motivate future research toward more reliable, consistent, and comprehensive surgical scene understanding.

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Nikolo Rohrmoser, Ghazal Ghazaei, Michael Sommersperger, Nassir Navab. 2026-03-26. Towards Comprehensive Real-Time Scene Understanding in Ophthalmic Surgery through Multimodal Image Fusion. https://arxiv.org/abs/2603.25555

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