The role of intraoperative optical coherence tomography in anterior segment surgical pathology: case series presentation

Session Details

Session Title: Anterior Segment Imaging II

Session Date/Time: Tuesday 25/09/2018 | 08:00-10:30

Paper Time: 09:10

Venue: Room A4

First Author: : O.Moraru ROMANIA

Co Author(s): :    M. Iliescu   C. Moraru                 

Abstract Details

Purpose:

Corneal surgeon and, also, the cataract surgeon faces intra-operative situations when poor visualization makes sometimes some surgical steps or decisions very difficult. Nowadays, intra-operative OCT (iOCT) is a valuable tool for real time cross-sectional view which improves the surgeon’s ability to see what’s happening inside the anterior chamber. Our paper is a case series presentation that demonstrates the advantages brought by the iOCT to the surgeon, in certain steps of the corneal transplant and cataract surgeries.

Setting:

Oculus Eye Clinic – Bucharest, Romania

Methods:

This is a 13 short case series presentation. We selected 12 corneal transplant and 1 phacoemulsification case, where iOCT, used at key steps during surgery, brought great advantages for surgery success. For all the presented cases, the use of iOCT helped the surgeon identify and properly solve each difficulty encountered during surgery. Among the corneal transplant cases, 4 were complex cases of Pseudophakia with Penetrating Keratoplasties (PK) and 8 were Ultra-Thin-Descemet Stripping Automated Keratoplasties (UT-DSAEK), both with and without complications during graft implantation. The donor lamella was prepared by the surgeon using an artificial anterior chamber device.

Results:

In 4 DSAEK eyes of the series, the proper descemet stripping was difficult due to stromal diffuse opacities, but iOCT helped in visualization the incomplete stripped descemet remnants. In 3 DSAEK cases the thin graft was by mistake folded during its implantation or during its positioning by corneal massage and iOCT was helpful in unrolling it correctly. In the 4 PK eyes and 1 DSAEK eye, with iOCT we checked the angle and iris position where the opaque host peripheral cornea allowed no visualization. In one cataract eye, the large accidental descemet detachment could be confirmed and managed using iOCT.

Conclusions:

Intra-operative OCT is known for its help in Descemet Membrane Endothelial Keratoplasty (DMEK), but there are less known the benefits and help in DSAEK techniques and even in cataract surgery. Often, the patient referred for corneal transplant has advanced corneal opacities which preclude good anterior chamber visualization. Intra-operative OCT becomes a valuable ally which allows better visualization that brings more confidence during several surgical steps and also higher safety profile. Moreover, when complications during graft implantation occur, iOCT proved to be very helpful, as well. IOCT is also valuable in cataract surgery, when some complications, such as Descemet detachment, occur.

Financial Disclosure:

-