RESUMO
BACKGROUND/AIMS: To describe the use of intraoperative online optical coherence tomography (iOCT) for improving deep anterior lamellar keratoplasty (DALK) surgery. METHODS: Retrospective case series of 6 eyes of 6 male patients with keratokonus, corneal dystrophy or herpetic stromal scars undergoing DALK were investigated using intraoperative optical coherence tomography and postsurgical image/video analysis. Main outcome measures were: visibility of surgical steps, especially, assessment of placement depth of injection needle, preparation of bare Descemet's membrane and drainage of interface fluid. RESULTS: iOCT enables real-time visualisation of all surgical steps of DALK procedure in all patients. Placement of air injection needle above Descemet's membrane was reliably monitored as was presence of bare Descemet's membrane and potential interface fluid. CONCLUSIONS: iOCT assists with visualisation of injection needle placement and with assessment of bare Descemet's membrane as well as interface fluid during the DALK procedure. Overall iOCT may be a helpful device that supports surgeons in all steps of DALK procedure.
Assuntos
Doenças da Córnea/cirurgia , Transplante de Córnea/métodos , Monitorização Intraoperatória , Sistemas On-Line , Tomografia de Coerência Óptica/métodos , Gravação em Vídeo , Adulto , Sistemas Computacionais , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Cultura de Órgãos , Período Pós-Operatório , Estudos Retrospectivos , Doadores de Tecidos , Resultado do TratamentoRESUMO
IMPORTANCE: Descemet membrane endothelial keratoplasty (DMEK) is a challenging procedure for the surgeon, particularly because of deficient visibility of the delicate tissue due to the natural en face view through the operating microscope. A cross-sectional view would greatly enhance intraoperative overview and enable the surgeon to better control the procedure. OBJECTIVE: To retrospectively analyze the use of intraoperative optical coherence tomography (iOCT) for improving the safety of DMEK. DESIGN: Intraoperative OCT during DMEK was performed in 26 eyes of 26 patients. We retrospectively analyzed imaging and video data. SETTING: Department of Ophthalmology, University of Cologne. PARTICIPANTS: Seven men and 19 women aged 39 to 93 years with corneal endothelial dysfunction undergoing DMEK. EXPOSURE: Descemet membrane endothelial keratoplasty. MAIN OUTCOMES AND MEASURES: Visibility of surgical steps, overall duration of DMEK, overall time for complete intraoperative air filling of the anterior chamber, and correlation between donor age and Descemet rolling behavior. RESULTS Intraoperative OCT enables visualization of all steps of the DMEK procedure. Overall mean (SD) duration of the DMEK procedure was 25.7 (6.9) minutes when using iOCT. Overall mean (SD) complete intraoperative anterior chamber air-filling time was 236 (108) seconds in contrast to 60 to 90 minutes for standard air-filling time. Descemet membrane rolling behavior showed significant inverse correlation between donor age (range, 39-93 years) and the extent of rolling (R2 = 0.5 [P = .006]). CONCLUSIONS AND RELEVANCE: Intraoperative OCT enhances the visibility of graft orientation and unfolding, thereby improving safety of the DMEK procedure. Overall, iOCT is a helpful device that may support surgeons in all steps of DMEK procedures.
Assuntos
Perda de Células Endoteliais da Córnea/cirurgia , Lâmina Limitante Posterior/patologia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Técnicas de Diagnóstico Oftalmológico , Tomografia de Coerência Óptica , Adulto , Idoso , Idoso de 80 Anos ou mais , Contagem de Células , Perda de Células Endoteliais da Córnea/diagnóstico , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Técnicas de Cultura de Órgãos , Estudos Retrospectivos , Doadores de TecidosRESUMO
Nearly real-time visualization of 3-D volumes is crucial for the use of optical coherence tomography (OCT) during microsurgery. With an ultrahigh speed spectral domain OCT coupled to a surgical microscope, on-line display of 7.2 rendered volumes at 87 megapixels per second is demonstrated. Calculating the A-scans from the spectra is done on a quad-core personal computer (PC), while dedicated software for the 3-D rendering is executed on a high performance video card. Imaging speed is practically only limited by the readout of the camera. First experiments show the feasibility of real-time 3-D OCT for guided interventions.
Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/instrumentação , Microcirurgia/instrumentação , Cirurgia Assistida por Computador/instrumentação , Tomografia de Coerência Óptica/instrumentação , Desenho de Equipamento , Análise de Falha de Equipamento , Sistemas On-Line , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
We tested a 1310-nm optical coherence tomograph coupled with a beam splitter on the front lens of an operating microscope for intraoperative, noncontact visualization of anterior segment procedures. This new modification of optical coherence tomography technology allows intraoperative, high-resolution, cross-sectional imaging and pachymetry of the cornea and sclera during anterior segment surgery. It is particularly helpful for lamellar dissection techniques such as deep anterior lamellar keratoplasty and trabeculectomy.
