Intraoperative optical coherence tomography-guided deep anterior lamellar keratoplasty
Gauging stromal dissection depth is crucial to successfully perform deep anterior lamellar keratoplasty (DALK) surgery. Intraoperative optical coherence tomography (iOCT) offers a promising tool to aid DALK surgery but visualization of surgical maneuvers is impaired due to artifacts from metallic in...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Taiwan Journal of Ophthalmology |
| Subjects: | |
| Online Access: | http://www.e-tjo.org/article.asp?issn=2211-5056;year=2023;volume=13;issue=1;spage=106;epage=109;aulast=Lin |
| Summary: | Gauging stromal dissection depth is crucial to successfully perform deep anterior lamellar keratoplasty (DALK) surgery. Intraoperative optical coherence tomography (iOCT) offers a promising tool to aid DALK surgery but visualization of surgical maneuvers is impaired due to artifacts from metallic instruments. We describe a novel surgical technique utilizing suture-assisted iOCT guidance that facilitates clear visualization of corneal dissection planes during DALK. A stromal dissection tunnel is performed with a Fogla probe and its depth is subsequently identified by threading a 1 cm segment of 8-0 nylon into the tunnel. In contrast to the Fogla probe, the 8-0 nylon is conspicuously highlighted on iOCT. If the tunnel is too superficial, a separate, deeper stromal tunnel can be created and visualized again with the 8-0 nylon suture and iOCT. This iterative process facilitates a deep stromal dissection, increasing the probability of successful big-bubble formation and Descemet baring DALK surgery. This technique was utilized for a successful big-bubble DALK in a patient with severe keratoconus. |
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| ISSN: | 2211-5056 2211-5072 |