Abstract
BackgroundTo report the feasibility of intraoperative spectral domain optical coherence tomography (OCT) using the RESCAN 700 for the visualization and evaluation of precut Descemet’s stripping automated endothelial keratoplasty (DSAEK) and prestripped Descemet’s membrane endothelial keratoplasty (DMEK) donor tissue.MethodsPrecut DSAEK (n = 11), prestripped DMEK (n = 4) preserved in a viewing chamber were examined by intraoperative OCT. Wholly intact donor corneas for penetrating keratoplasty (PK) (n = 8) were also examined as controls. The obtained images were analyzed qualitatively for characteristics of each type of donor.ResultsFor each type of donor, characteristic images were consistently obtained by intraoperative OCT in both the front and back views through the viewing chamber. In wholly intact donors for PK, appearance of normal corneal curvature and stromal texture with high reflectivity of epithelium and endothelium cell layers were clearly visualized. In precut DSAEK donors, precut lines were characteristically visualized in addition to the intact donor cornea images. In prestripped DMEK donors, identical OCT images to the intact donor cornea were noted when observed from the anterior surface. However, peripheral partial detachments of Descemet’s membrane were characteristically observed in all prestripped DMEK donors when viewed from the back of the viewing chamber.ConclusionRapid visualization and rough evaluation of donor tissues for PK, precut DSAEK and prestripped DMEK donor corneas by intraoperative OCT was consistently possible through the viewing chamber. Therefore, this device may be used as an alternative of AS-OCT when the eyebank does not have their own AS-OCT. Although the peripheral detachment in DMEK donors are quite common and clinically non-problematic in DMEK donor quality and subsequent DMEK surgeries, it may be useful to distinguish between wholly intact PK donors and prestripped DMEK donors, enabling to prevent mix-ups of donors, especially when several different types of keratoplasties are scheduled in a same day in one operating theater.
Highlights
To report the feasibility of intraoperative spectral domain optical coherence tomography (OCT) using the RESCAN 700 for the visualization and evaluation of precut Descemet’s stripping automated endothelial keratoplasty (DSAEK) and prestripped Descemet’s membrane endothelial keratoplasty (DMEK) donor tissue
In wholly intact penetrating keratoplasty (PK) donors, appearance of normal corneal curvature, not quantitatively measured, and normal stromal texture with high reflectivity of the epithelium and endothelium cell layers were clearly visualized in all donors (n = 8) (Fig. 1)
In prestripped DMEK donors, no characteristic images were noted by SD-OCT when observed from the anterior surface, since peripheral image could not be obtained from the anterior surface observation
Summary
To report the feasibility of intraoperative spectral domain optical coherence tomography (OCT) using the RESCAN 700 for the visualization and evaluation of precut Descemet’s stripping automated endothelial keratoplasty (DSAEK) and prestripped Descemet’s membrane endothelial keratoplasty (DMEK) donor tissue. The use of precut DSAEK tissue [19] or prestripped DMEK tissue [20] supplied by the eyebank has greatly shortened the operation time, avoids a large capital investment in an expensive microkeratome machine for DSAEK and avoids tissue loss due to unsuccessful Descemet’s membrane stripping/harvesting in DMEK. Evaluation of these premade endothelial keratoplasty tissues before surgery can be successfully and effectively performed by slit lamp biomicroscopy and specular microscopy. Some eyebanks have adopted AS-OCT as their standard procedures for tissue evaluation [23]
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