Real-Time Intraoperative OCT Imaging: Lamellar Keratoplasty and Donor Tissue Preparation

Cabot, Florence

Real-Time Intraoperative OCT Imaging: Lamellar Keratoplasty and Donor Tissue Preparation

Friday, April 25, 2014

KIOSKS (Boston Convention and Exhibition Center)

Florence Cabot, MD, Bascom Palmer Eye Institute, Miami, Florida, USA

Marco Ruggeri, PhD, Bascom Palmer Eye Institute - University of Miami Miller School of Medicine, Miami, FL, USA

Carolina P. de Freitas, BS, Bascom Palmer Eye Institute, Miami, FL, USA

George D. Kymionis, MD, PhD, University of Crete, Heraklion, Greece

Pravin K. Vaddavalli, MD, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India

Jean-Marie A. Parel, PhD, FARVO, University of Miami Miller School of Medicine, Miami, FL, USA

Sonia H. Yoo, MD, Bascom Palmer Eye Institute, Miami, FL, USA

Narrative Responses:

Purpose
To assess intraoperative Spectral Domain OCT imaging in Descemet Stripping Automated Endothelial Keratoplasty (DSAEK), Deep anterior lamellar keratoplasty (DALK) and donor tissue preparation for Descemet's membrane endothelial keratoplasty (DMEK).

Methods
Six patients were included: 3 underwent DSAEK and 3 others DALK. A supine intraoperative high axial resolution OCT built by the BPEI’s Ophthalmic Biophysics Center was used for DSAEK and DALK surgeries as well as for DMEK donor tissue preparation. SD-OCT scans of the cornea were performed intraoperatively at each step of the procedure: before and after insertion of the donor graft for DSAEK and during the intrastromal air injection (big bubble technique) for DALK. For DMEK donor tissue preparation, reverse big bubble technique was used and assisted by real-time OCT imaging.

Results
During DSAEKs cases, no interface space was detectable in the 3 patients and only one presented an irregular host-donor interface. The graft was well attached at the end of the surgery in all 3 cases. During DALKs, corneal perforation occurred in 2 cases and required conversion to penetrating keratoplasty; in the other case, dissection of the Descemet’s membrane from the overlying stroma was obtained after intrastromal air injection. SD-scans enabled to image reverse big bubble, emphysema and corneal perforation in real-time during DMEK preparation.

Conclusion
Intraoperative real-time SD-OCT is a useful technique to assist lamellar keratoplasty. Surgical tool tracking and integration of the technology into the operating microscope may improve its ease of use and benefits in lamellar keratoplasty surgery and donor tissue preparation.