Use of intraoperative fourier-domain anterior segment optical coherence tomography during descemet stripping endothelial keratoplasty.
OBJECTIVE
To evaluate the intraoperative use of handheld Fourier-domain optical coherence tomography (OCT) during Descemet stripping automated endothelial keratoplasty (DSAEK) to assess the donor-host interface.


METHODS
Prospective, observational case series.


METHODS
Six patients undergoing DSAEK surgery were included. OCT scans of the cornea were performed intraoperatively after insertion of the donor disc, after instillation of air in the anterior chamber beneath the disc, after vent incisions in the host cornea in each quadrant, following air-fluid exchange at the end of operation, and on day 1 after surgery. The central 3 mm of each cornea was scanned. The broadest gap between donor and host cornea (interface space) was measured.


RESULTS
Adequate readings could be obtained from all patients without any complications. In 2 patients there was a decrease in the width of the interface space after each surgical step documented by the OCT scans. At the end of their operation, no interface space was detectable. In 2 patients, interface space disappeared after the vent incisions and did not reappear during the further course of the surgery. In further 2 patients the separation between the host and donor was still detectable at the end of the operation. All patients had no detectable interface gap on day 1.


CONCLUSIONS
Handheld anterior segment OCT can be used to assess the host-donor interface in lamellar corneal transplantation surgery. Donor adherence can occur in spite of residual interface space at the end of surgery. Further studies should be conducted to answer the question of which surgical steps are useful in assisting with donor adhesion.
Knecht
Pascal B
PB
University Hospital Zurich, Department of Ophthalmology, Frauenklinikstrasse 24, Zurich, Switzerland. pascalknecht@gmx.ch
Kaufmann
Claude
C
Menke
Marcel N
MN
Watson
Stephanie L
SL
Bosch
Martina M
MM
D000368:Aged; D000369:Aged, 80 and over; D002448:Cell Adhesion; D003315:Cornea / Q000473:pathology*; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005583:Fourier Analysis; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014019:Tissue Donors; D041623:Tomography, Optical Coherence