Abstract
PurposeRecently, intraoperative optical coherence tomography (iOCT) has evolved in the field of ophthalmic surgery. So far, the use of iOCT was mainly focused to lamellar keratoplasty, especially deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). The aim of this study was to report our experiences with iOCT to introduce new possibilities of this application.MethodsWe used iOCT in 18 patients who underwent the following surgeries: DALK, DMEK, penetrating keratoplasty, autologous limbal transplantation, transscleral suture fixation of a posterior chamber lens, pannus removal on corneal surface and newborn investigation in Peters’ anomaly. We obtained qualitative video data for all procedures.ResultsWith the iOCT, the cannula placement during DALK preparation of the recipient cornea and bubble formation could be visualized to improve the success rate of the big bubble injection. In DMEK, the iOCT enables the visualization of Descemet’s membrane removal in the recipient and graft orientation as well as better control of graft attachment. The iOCT enables intraoperative visualization of the graft–host interface during penetrating keratoplasty. During autologous limbal transplantation, transscleral suture fixation of a posterior chamber lens and removal of corneal surface pannus the iOCT is capable of showing the thickness of lamellar preparations to avoid penetrations and to save healthy recipient’s tissue.ConclusionThe iOCT is a helpful device for intraoperative anterior segment imaging not only for DALK and DMEK. It is also beneficial in penetrating keratoplasty and every other form of lamellar preparation during corneoscleral surgery.
Highlights
Intraoperative optical coherence tomography was established in the field of ophthalmic surgery
The intraoperative optical coherence tomography (iOCT) is a helpful device for intraoperative anterior segment imaging for deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK)
It is beneficial in penetrating keratoplasty and every other form of lamellar preparation during corneoscleral surgery
Summary
Intraoperative optical coherence tomography (iOCT) was established in the field of ophthalmic surgery. The first studies reported on the use of handheld iOCT devices [1, 2]. A more feasible option seems to be the use of microscope mounted devices [3]. First reports of intraoperative OCT use were mainly focused on vitreoretinal surgery [3–5], including macular hole surgery [2] and retinal detachment [6].In anterior segment surgery, the use of iOCT was reported for lamellar keratoplasty. In deep anterior lamellar keratoplasty (DALK), the iOCT can be used to visualize the placement of the needle for the injection of the big bubble. The preparation of the bare Descemet’s membrane and the visualization of interface fluids can be assisted with iOCT [7, 8]. The use of iOCT for big bubble formation in DALK has been reported [9]
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