Free Papers

The role of intra-operative optical coherence tomography in reinterventions for early postoperative complications in anterior segment surgeries

Free Paper Details

First Author: O.Moraru ROMANIA

Co Author(s):    M. Iliescu                    

Abstract Details

Purpose:

To present the importance of intraoperative optical coherence tomography (i-OCT) in solving early postoperative complications in different anterior segment (AS) surgeries, where the surgical microscope doesn’t allow a proper view of the anterior segment structures.

Setting:

Oculus Eye Clinic – Bucharest, Romania

Methods:

We considered six eyes with different pathology which underwent apparently uncomplicated different anterior segment surgeries and presented early postoperative complications, necessitating re-intervention: one phacoemulsification case with missed Descemet membrane (DM) detachment, one Deep Anterior Lamellar Keratoplasty (DALK) case, which presented postoperatively with double AC, one Endothelial Keratoplasty (EK) case with atalamia in the first postoperative day, two cases of penetrating keratoplasty (PK) - one performed manually and one with FemtoLaser -, which were complicated with retained host DM and one eye with trabeculectomy necessitating needling. All re-intervention procedures were done with continuous live visualization of the AS, under i-OCT guiding.

Results:

In all cases the surgeon managed to solve the complication properly: reattachment of DM in the cataract and DALK cases, deepening the AC in EK case, proper extraction of retained DM in PK cases and re-filtration under the scleral flap in the trabeculectomy case. Although the primary surgeries were done without using intraoperative imaging, i-OCT proved to be very useful in visualization of the both anterior chamber structures and perilimbal scleral tissues during the reinterventions. The clinical examination and the AS-OCT performed in the first day post-readmission and in the following days showed complete resolution of complications in each patient.

Conclusions:

Although the early complications in anterior segment surgeries are not frequent, most of them are serious complications, which can irreversibly compromise the surgery result. Thus, they must be addressed properly and at the right time, even with a new surgical procedure, if needed. Sometimes, the re-intervention is challenging or uncertain, due to poor visualization of the anterior chamber or anterior segment details. With the help of i-OCT, the surgeon makes these re-intervention procedures safer and more accurate, being able to completely solve each particular case.

Financial Disclosure:

-