scholarly journals Intraoperative optical coherence tomography guided corneal sweeping for removal of remnant Interface fluid during ultra-thin Descemet stripping automated endothelial keratoplasty

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael Mimouni ◽  
Martin Kronschläger ◽  
Manuel Ruiss ◽  
Oliver Findl
Keyword(s):  
Optical Coherence Tomography ◽  
Retrospective Study ◽  
Optical Coherence ◽  
Endothelial Keratoplasty ◽  
Intraoperative Optical Coherence Tomography ◽  
Graft Thickness

Abstract Background Remnant interface fluid following Descemet stripping automated endothelial keratoplasty (DSAEK) is associated with postoperative detachments. The aim of this study was to assess outcomes of intraoperative optical coherence tomography (iOCT) guided meticulous peripheral corneal sweeping for removal of interface fluid during ultra-thin (UT) DSAEK. Methods This retrospective study included all eyes underwent iOCT guided UT-DSAEK from October 2016 to February 2018 at the Hanusch Hospital, Vienna, Austria. Peripheral meticulous corneal sweeping was performed to remove excess fluid. Central graft thickness (CGT) was measured prior to surgery, after graft bubbling and after corneal sweeping. Remnant interface fluid rates were compared between eyes that underwent rebubbling and those that did not. Results Overall, 28 eyes of 28 patients with a mean age of 73.9 ± 10.0 years were included. An iOCT guided meticulous peripheral sweeping was performed in 89.3% (n = 25) of the cases. Following 84% (n = 21) of the peripheral sweeping performed, remnant fluid was no longer identified. Following peripheral sweeping the interface fluid height was reduced from 17.31 ± 15.96 μm to 3.46 ± 9.52 μm (p < 0.001) and CGT was reduced by 7% (p < 0.001). Rebubbling was performed in 17.9% (n = 5) of the cases. The rebubbling group had a greater proportion of patients that had remnant fluid identified with iOCT at the end of surgery despite meticulous peripheral sweeping (60.0% versus 4.4%, p = 0.01). Conclusion The iOCT identified subclinical remnant fluid in nearly 90% of UT-DSAEK cases. An iOCT guided peripheral corneal sweeping led to resolution of interface fluid in a majority of cases. Eyes with persistent remnant fluid despite peripheral corneal sweeping are more likely to require subsequent rebubbling.

Intraoperative Optical Coherence Tomography–Assisted Descemet Membrane Endothelial Keratoplasty

Cornea ◽  
2020 ◽  
Vol 39 (6) ◽  
pp. 674-679 ◽  
Author(s):  
Marc B. Muijzer ◽  
Nienke Soeters ◽  
Daniel A. Godefrooij ◽  
Chantal M. van Luijk ◽  
Robert P. L. Wisse
Keyword(s):  
Optical Coherence Tomography ◽  
Optical Coherence ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Intraoperative Optical Coherence Tomography

scholarly journals ‘Acute-angled bevel’ sign to assess donor lenticule orientation in ultra-thin descemet stripping automated endothelial keratoplasty

2019 ◽  
Vol 12 (2) ◽  
pp. e227927 ◽  
Author(s):  
Jeewan S Titiyal ◽  
Manpreet Kaur ◽  
Farin Shaikh ◽  
Aafreen Bari
Keyword(s):  
Optical Coherence Tomography ◽  
Anterior Segment ◽  
Acute Angle ◽  
Optical Coherence ◽  
Endothelial Keratoplasty ◽  
Anterior Segment Oct ◽  
Intraoperative Optical Coherence Tomography ◽  
Congenital Hereditary Endothelial Dystrophy ◽  
Graft Insertion

A 6.5-year-old boy with congenital hereditary endothelial dystrophy underwent clear corneal ultra-thin descemet stripping automated endothelial keratoplasty (DSAEK). After graft insertion, it was difficult to assess graft orientation due to hazy cornea. Intraoperative optical coherence tomography (iOCT) showed a well-attached graft and the bevelled edge of donor lenticule made an acute angle with the overlying stroma. Postoperative anterior segment OCT confirmed the presence of acute-angled bevel sign. A wetlab experiment was performed with experimental corneoscleral tissues to confirm the findings. Donor lenticule was injected in the artificial chamber with stromal-side up as well as stromal side-down. ‘Acute-angled bevel sign’ was observed on iOCT in the experimental cases with stromal-side up. In inverse graft, the acute-angled bevel was not observed, instead the configuration was obtuse angled. Identifying the ‘acute-angled bevel sign’ on iOCT confirms correct graft orientation after unfolding and is extremely useful for hazy corneas and ultrathin DSAEK lenticules.

scholarly journals Long-term observation of graft thickness and shape in Descemet stripping and automated endothelial keratoplasty

2019 ◽  
Vol 30 (1) ◽  
pp. 155-161
Author(s):  
Yi-Ching Hsieh ◽  
Chun-Chi Chiang ◽  
Yi-Yu Tsai
Keyword(s):  
Optical Coherence Tomography ◽  
Retrospective Study ◽  
Anterior Segment ◽  
Endothelial Keratoplasty ◽  
Graft Thickness ◽  
Asymmetrical Shape ◽  
Optical Zone ◽  
Long Term Observation ◽  
Common Shape

Purpose: To evaluate the thickness and shape of the posterior lamellar graft in Descemet stripping and automated endothelial keratoplasty after long-term observation. Methods: All patients who underwent Descemet stripping and automated endothelial keratoplasty including simple and triple Descemet stripping and automated endothelial keratoplasty between August 2009 and May 2014 were enrolled in this retrospective study. To assess postoperative thickness and shape of the Descemet stripping and automated endothelial keratoplasty graft, images of the graft taken at the center (C), mid-periphery at 4 mm optical zone (P1), and periphery at 6 mm optical zone (P2) at 1, 2, and 3 years postoperatively were obtained using anterior segment optical coherence tomography. Results: C:P1 was 0.96, 0.96, and 0.95 at 1, 2, and 3 years postoperatively, respectively. C:P2 was 0.85, 0.84, and 0.83 at 1, 2, and 3 years postoperatively, respectively. There was a greater thinning of the central graft thickness compared with the peripheral graft thickness. The shapes of the posterior lamellar graft were variable, such as concave, asymmetrical, planar, irregular, and convex meniscus shapes. The most common shape was asymmetrical shape at 1 year postoperatively and concave at 2 and 3 years postoperatively. The most common shape of the posterior lamellar grafts was asymmetrical shape (38.18%) at 1 year postoperatively, followed by concave (34.54%), planar (20.00%), irregular (5.45%), and convex (1.81%) shapes. The most common shape was concave shape (44.44% and 57.14% for 2 and 3 years postoperatively, respectively), followed by asymmetrical (27.77% and 17.85%, respectively), planar (16.66% and 17.85%, respectively), and irregular (11.11% and 7.14%, respectively) shapes. Conclusion: In our study, concave meniscus was not the only observed shape of the graft. The shape and thickness of the graft did not stabilize even 3 years postoperatively in some patients. These findings should be taken into consideration in a combination of Descemet stripping and automated endothelial keratoplasty and cataract surgery.

scholarly journals Correlation between vaulting intraoperative and postoperative of EVO implantable Collamer lens: a retrospective study of real-time observations of vaulting using the RESCAN 700 system

2020 ◽  
Author(s):  
Nian Guan ◽  
Xiao-Nong Zhang ◽  
Wan-Jun Zhang
Keyword(s):  
Optical Coherence Tomography ◽  
Intraocular Pressure ◽  
Retrospective Study ◽  
Multivariable Analysis ◽  
Anterior Chamber Depth ◽  
Crystalline Lens ◽  
Optical Coherence ◽  
Implantable Collamer Lens ◽  
Corrected Visual Acuity ◽  
Intraoperative Optical Coherence Tomography

Abstract Background: The prediction of implantable Collamer lens (ICL) vaulting is one of the most important parameters for ICL implantation for safety, aqueous humor circulation, and lens transparency.Methods: This was a retrospective study. A RESCAN 700 was used for intraoperative observation of vaulting. Spectral-domain optical coherence tomography was used for imaging. Results: Finally, 51 patients (102 eyes) were included in the study. Compared with the eyes with normal vaulting, those with high vaulting had higher preoperative diopter values (P=0.039), lower preoperative corrected visual acuity (P=0.006), lower preoperative intraocular pressure (P=0.029), higher preoperative anterior chamber depth (P=0.004), lower preoperative crystalline lens rise (P=0.046), higher ICL spherical equivalent (P=0.030), higher intraoperative vaulting (P<0.001), and lower intraocular pressure at 1 month (P=0.045). The multivariable analysis showed that the only factors independently associated with high vaulting at 1 month after surgery was the intraoperative vaulting value (odds ratio=1.005, 95% confidence interval: 1.002-1.007, P<0.001). The intraoperative and 1-month postoperative vaulting values were correlated (R2=0.562).Conclusions: The RESCAN700 system can be used to perform intraoperative optical coherence tomography to predict the vaulting value at 1 month.

scholarly journals Intraoperative Optical Coherence Tomography Imaging in Corneal Surgery: A Literature Review and Proposal of Novel Applications

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Hiroshi Eguchi ◽  
Fumika Hotta ◽  
Shunji Kusaka ◽  
Yoshikazu Shimomura
Keyword(s):  
Optical Coherence Tomography ◽  
Corneal Transplantation ◽  
Anterior Segment ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Optical Coherence ◽  
Endothelial Keratoplasty ◽  
Corneal Surgery ◽  
Anterior Lamellar Keratoplasty ◽  
Intraoperative Optical Coherence Tomography

Intraoperative optical coherence tomography (iOCT) is widely used in ophthalmic surgeries for cross-sectional imaging of ocular tissues. The greatest advantage of iOCT is its adjunct diagnostic efficacy, which facilitates to decision-making during surgery. Since the development of microscopic-integrated iOCT (MIOCT), it has been widely used mainly for vitreoretinal and anterior segment surgeries. In corneal transplantation, MIOCT allows surgeons to visualise structure underneath the turbid and distorted cornea, which are impossible to visualise with a usual microscope. Real-time visualisation of hard-to-see area reduces the operation time and leads to favorable surgical outcomes. The use of MIOCT is advantageous for a variety of corneal surgical procedures. Here, we have reviewed articles focusing on the utility of iOCT  and MIOCT in penetrating keratoplasty, deep anterior lamellar keratoplasty, Descemet stripping automated endothelial keratoplasty, and Descemet membrane endothelial keratoplasty. The applications of MIOCT to corneal surgery in terms of surgical education for trainees, emergency surgery, and novel surgery are also discussed, with our cases performed using RESCAN® 700.

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