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 |
| _version_ | 1797866352097099776 |
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| author | Charles C Lin Wen-Shin Lee |
| author_facet | Charles C Lin Wen-Shin Lee |
| author_sort | Charles C Lin |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-09T23:23:55Z |
| format | Article |
| id | doaj.art-384ef286d41b40848cb8c092f0169c00 |
| institution | Directory Open Access Journal |
| issn | 2211-5056 2211-5072 |
| language | English |
| last_indexed | 2024-04-09T23:23:55Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Taiwan Journal of Ophthalmology |
| spelling | doaj.art-384ef286d41b40848cb8c092f0169c002023-03-21T11:27:43ZengWolters Kluwer Medknow PublicationsTaiwan Journal of Ophthalmology2211-50562211-50722023-01-0113110610910.4103/tjo.TJO-D-22-00151Intraoperative optical coherence tomography-guided deep anterior lamellar keratoplastyCharles C LinWen-Shin LeeGauging 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.http://www.e-tjo.org/article.asp?issn=2211-5056;year=2023;volume=13;issue=1;spage=106;epage=109;aulast=Lindeep anterior lamellar keratoplastyintraoperative optical coherence tomographykeratoconus |
| spellingShingle | Charles C Lin Wen-Shin Lee Intraoperative optical coherence tomography-guided deep anterior lamellar keratoplasty Taiwan Journal of Ophthalmology deep anterior lamellar keratoplasty intraoperative optical coherence tomography keratoconus |
| title | Intraoperative optical coherence tomography-guided deep anterior lamellar keratoplasty |
| title_full | Intraoperative optical coherence tomography-guided deep anterior lamellar keratoplasty |
| title_fullStr | Intraoperative optical coherence tomography-guided deep anterior lamellar keratoplasty |
| title_full_unstemmed | Intraoperative optical coherence tomography-guided deep anterior lamellar keratoplasty |
| title_short | Intraoperative optical coherence tomography-guided deep anterior lamellar keratoplasty |
| title_sort | intraoperative optical coherence tomography guided deep anterior lamellar keratoplasty |
| topic | deep anterior lamellar keratoplasty intraoperative optical coherence tomography keratoconus |
| url | http://www.e-tjo.org/article.asp?issn=2211-5056;year=2023;volume=13;issue=1;spage=106;epage=109;aulast=Lin |
| work_keys_str_mv | AT charlesclin intraoperativeopticalcoherencetomographyguideddeepanteriorlamellarkeratoplasty AT wenshinlee intraoperativeopticalcoherencetomographyguideddeepanteriorlamellarkeratoplasty |