Evaluation of Time to Donor Lenticule Apposition Using Intraoperative Optical Coherence Tomography in Descemet Stripping Automated Endothelial Keratoplasty.

Abstract

To evaluate the time to donor lenticule apposition in cases of Descemet stripping automated endothelial keratoplasty (DSAEK) using microscope-integrated intraoperative optical coherence tomography (iOCT). Thirty eyes of 27 patients planned to undergo Descemet stripping automated endothelial keratoplasty were enrolled in this prospective study. In group I (n = 10), continuous intracameral positive pressure was maintained for 8 minutes. In group II (n = 10) and group III (n = 10), external corneal massage was initiated simultaneously with positive intracameral air pressure. The external corneal massage was continued till complete resolution of interface fluid; the positive intracameral pressure was maintained for 8 minutes in group II and for 5 minutes in group III. The host-donor relationship was continuously monitored with the iOCT. The main outcome measure was time to complete donor lenticule apposition. In group I, the interface fluid persisted after 8 minutes of positive intracameral pressure in all eyes (10/10); hence an external corneal massage was required to achieve optimal donor adherence. In groups II and III, all eyes (20/20) had complete resolution of the interface fluid at the end of 3 minutes. In 100% of the eyes (30/30), the grafts were attached after anterior chamber decompression as seen on the iOCT. In all cases, the donor lenticules were adhered in the postoperative period. iOCT helps in understanding that the donor lenticule is well apposed within 1 to 3 minutes with the technique of simultaneous positive intracameral pressure and external corneal massage. This knowledge minimizes the waiting time for graft apposition and prevents prolonged intraocular pressure elevation.