An Overview of Intraoperative OCT-Assisted Lamellar Corneal Transplants: A Game Changer?
Intraoperative optical coherence tomography (iOCT) is a noninvasive imaging technique that gives real-time dynamic feedback on surgical procedures. iOCT was first employed in vitreoretinal surgery, but successively served as a guidance in several anterior segment surgical approaches: keratoplasty, i...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-03-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/3/727 |
| _version_ | 1797472023834787840 |
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| author | Matteo Mario Carlà Francesco Boselli Federico Giannuzzi Gloria Gambini Tomaso Caporossi Umberto De Vico Luigi Mosca Laura Guccione Antonio Baldascino Clara Rizzo Raphael Kilian Stanislao Rizzo |
| author_facet | Matteo Mario Carlà Francesco Boselli Federico Giannuzzi Gloria Gambini Tomaso Caporossi Umberto De Vico Luigi Mosca Laura Guccione Antonio Baldascino Clara Rizzo Raphael Kilian Stanislao Rizzo |
| author_sort | Matteo Mario Carlà |
| collection | DOAJ |
| description | Intraoperative optical coherence tomography (iOCT) is a noninvasive imaging technique that gives real-time dynamic feedback on surgical procedures. iOCT was first employed in vitreoretinal surgery, but successively served as a guidance in several anterior segment surgical approaches: keratoplasty, implantable Collamer lens (ICL) implantation, and cataract surgery. Among all of those approaches, the unbeatable features of iOCT are fully exploited in anterior and posterior lamellar keratoplasty, and the purpose of this review is to focus on the advantages and shortfalls of iOCT in these techniques, in order to assess whether this technology could be a real step forward. In deep anterior lamellar keratoplasty (DALK), iOCT is useful to evaluate the needle depth into the corneal stroma, the big bubble dissection plane, and residual stromal bed, thus aiding the standardization of the technique and the reduction of failures. In Descemet stripping automated endothelial keratoplasty (DSAEK), iOCT allowed for clear visibility of fluid at the graft/host interface, allowing for immediate rescue maneuvers and granting the best graft apposition. In Descemet membrane endothelial keratoplasty (DMEK), iOCT can track the lenticule unfolding in real time and assess graft orientation even in severe hazy corneas, thus optimizing surgical times, as well as avoiding the use of potentially hazardous exterior markers (such as the “S” stamp) and preventing unnecessary manipulation of the graft. Overall, the role of iOCT appeared crucial in several complicated cases, overcoming the difficulties of poor visualization in a fast, non-invasive way, thus raising this approach as possible gold standard for challenging conditions. Further improvements in the technology may enable autonomous centering and tracking, overcoming the current constraint of instrument-induced shadowing. |
| first_indexed | 2024-03-09T19:56:11Z |
| format | Article |
| id | doaj.art-c229d401f290413d858d8e2d862cca1b |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T19:56:11Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-c229d401f290413d858d8e2d862cca1b2023-11-24T00:56:19ZengMDPI AGDiagnostics2075-44182022-03-0112372710.3390/diagnostics12030727An Overview of Intraoperative OCT-Assisted Lamellar Corneal Transplants: A Game Changer?Matteo Mario Carlà0Francesco Boselli1Federico Giannuzzi2Gloria Gambini3Tomaso Caporossi4Umberto De Vico5Luigi Mosca6Laura Guccione7Antonio Baldascino8Clara Rizzo9Raphael Kilian10Stanislao Rizzo11Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, ItalyOphthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, ItalyOphthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, ItalyOphthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, ItalyOphthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, ItalyOphthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, ItalyOphthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, ItalyOphthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, ItalyOphthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, ItalyOphthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, ItalyOphthalmology Unit, University of Verona, 37134 Verona, ItalyOphthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, ItalyIntraoperative optical coherence tomography (iOCT) is a noninvasive imaging technique that gives real-time dynamic feedback on surgical procedures. iOCT was first employed in vitreoretinal surgery, but successively served as a guidance in several anterior segment surgical approaches: keratoplasty, implantable Collamer lens (ICL) implantation, and cataract surgery. Among all of those approaches, the unbeatable features of iOCT are fully exploited in anterior and posterior lamellar keratoplasty, and the purpose of this review is to focus on the advantages and shortfalls of iOCT in these techniques, in order to assess whether this technology could be a real step forward. In deep anterior lamellar keratoplasty (DALK), iOCT is useful to evaluate the needle depth into the corneal stroma, the big bubble dissection plane, and residual stromal bed, thus aiding the standardization of the technique and the reduction of failures. In Descemet stripping automated endothelial keratoplasty (DSAEK), iOCT allowed for clear visibility of fluid at the graft/host interface, allowing for immediate rescue maneuvers and granting the best graft apposition. In Descemet membrane endothelial keratoplasty (DMEK), iOCT can track the lenticule unfolding in real time and assess graft orientation even in severe hazy corneas, thus optimizing surgical times, as well as avoiding the use of potentially hazardous exterior markers (such as the “S” stamp) and preventing unnecessary manipulation of the graft. Overall, the role of iOCT appeared crucial in several complicated cases, overcoming the difficulties of poor visualization in a fast, non-invasive way, thus raising this approach as possible gold standard for challenging conditions. Further improvements in the technology may enable autonomous centering and tracking, overcoming the current constraint of instrument-induced shadowing.https://www.mdpi.com/2075-4418/12/3/727anterior segment iOCTintraoperative optical coherence tomographymicroscope-integrated optical coherence tomographylamellar keratoplastyDALKDSAEK |
| spellingShingle | Matteo Mario Carlà Francesco Boselli Federico Giannuzzi Gloria Gambini Tomaso Caporossi Umberto De Vico Luigi Mosca Laura Guccione Antonio Baldascino Clara Rizzo Raphael Kilian Stanislao Rizzo An Overview of Intraoperative OCT-Assisted Lamellar Corneal Transplants: A Game Changer? Diagnostics anterior segment iOCT intraoperative optical coherence tomography microscope-integrated optical coherence tomography lamellar keratoplasty DALK DSAEK |
| title | An Overview of Intraoperative OCT-Assisted Lamellar Corneal Transplants: A Game Changer? |
| title_full | An Overview of Intraoperative OCT-Assisted Lamellar Corneal Transplants: A Game Changer? |
| title_fullStr | An Overview of Intraoperative OCT-Assisted Lamellar Corneal Transplants: A Game Changer? |
| title_full_unstemmed | An Overview of Intraoperative OCT-Assisted Lamellar Corneal Transplants: A Game Changer? |
| title_short | An Overview of Intraoperative OCT-Assisted Lamellar Corneal Transplants: A Game Changer? |
| title_sort | overview of intraoperative oct assisted lamellar corneal transplants a game changer |
| topic | anterior segment iOCT intraoperative optical coherence tomography microscope-integrated optical coherence tomography lamellar keratoplasty DALK DSAEK |
| url | https://www.mdpi.com/2075-4418/12/3/727 |
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