Indications for intraoperative anterior segment optical coherence tomography in corneal surgery
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ORIGINAL PAPER
Indications for intraoperative anterior segment optical coherence tomography in corneal surgery Stefan J. Lang Philip Maier
. Sonja Heinzelmann . Daniel Bo¨hringer . Thomas Reinhard .
Received: 26 November 2019 / Accepted: 23 May 2020 Ó The Author(s) 2020
Abstract Purpose Recently, 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. Methods We 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. Results With 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. Conclusion The 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. Keywords Anterior segment optical coherence tomography iOCT Cornea DALK DMEK Penetrating keratoplasty
Background Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10792-020-01442-0) contains supplementary material, which is available to authorized users. S. J. Lang (&) S. Heinzelmann D. Bo¨hringer T. Reinhard P. Maier Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany
Recently, 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]. However, 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
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[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 anteri
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