Role of Microscope-Intraoperative Optical Coherence Tomography in Pediatric Keratoplasty: AComparative Study

Abstract

We evaluate the role of microscope-integrated intraoperative optical coherence tomography (i-OCT) in pediatric keratoplasty. Combined prospective and retrospective, comparative, interventional study conducted at the Dr Rajendra Prasad Center for Ophthalmic Sciences in New Dehli, India. Seventy-five children ≤16 years of age undergoing planned keratoplasty were divided into 2 groups and compared regarding intraoperative course and postoperative outcome. In group 1 (prospective group, n= 56), preoperative anterior segment visualization was performed clinically, with ultrasound biomicroscopy (UBM) and i-OCT and keratoplasty was commenced under i-OCT microscope. In group 2 (retrospective group, n= 19), a conventional microscope was used during keratoplasty. In group 1, i-OCT, UBM, and clinical examination detected retrocorneal membrane in 10%, 7.5%, and 5% (P= .005), iris adhesions in 62.5%, 57.5%, and 20% (P= .02), iris stump in aniridia 15%, 10%, and 0% (P= .001), shallow central anterior chamber in 22.5%, 22.5%, and 7.5% (P= .003), and shallow peripheral anterior chamber in 65%, 60%, and 17.5% (P= .004) of children, respectively. The use of i-OCT affected intraoperative surgeon decision making in 45% and 33% of cases of anterior and posterior lamellar keratoplasty, respectively. During penetrating keratoplasty, concomitant intraoperative procedures were higher in group 1 than in group 2, namely synechiolysis (19/40 vs 2/15; P= .1), pupilloplasty (4/40 vs 0/15; P= .02), lens extraction (4/40 vs 1/15; P= .5), and anterior vitrectomy (2/40 vs 1/15; P= .4). Postoperative secondary interventions were lower (P= .04) in group 1 (48.21% vs 94.74%). Anterior segment imaging with i-OCT and UBM immediately before surgery improves the surgical planning of children with corneal opacities. In addition, the use of i-OCT refines intraoperative steps, thereby optimizing the postoperative outcome of pediatric keratoplasty.