title: Evaluation of Time to Donor Lenticule Apposition Using Intraoperative Optical Coherence Tomography in Descemet Stripping Automated Endothelial Keratoplasty.
abstract: OBJECTIVE
  To evaluate the time to donor lenticule apposition in cases of Descemet stripping automated endothelial keratoplasty (DSAEK) using microscope-integrated intraoperative optical coherence tomography (iOCT).
  
  
  METHODS
  Thirty eyes of 27 patients planned to undergo Descemet stripping automated endothelial keratoplasty were enrolled in this prospective study. In group I (n = 10), continuous intracameral positive pressure was maintained for 8 minutes. In group II (n = 10) and group III (n = 10), external corneal massage was initiated simultaneously with positive intracameral air pressure. The external corneal massage was continued till complete resolution of interface fluid; the positive intracameral pressure was maintained for 8 minutes in group II and for 5 minutes in group III. The host-donor relationship was continuously monitored with the iOCT. The main outcome measure was time to complete donor lenticule apposition.
  
  
  RESULTS
  In group I, the interface fluid persisted after 8 minutes of positive intracameral pressure in all eyes (10/10); hence an external corneal massage was required to achieve optimal donor adherence. In groups II and III, all eyes (20/20) had complete resolution of the interface fluid at the end of 3 minutes. In 100% of the eyes (30/30), the grafts were attached after anterior chamber decompression as seen on the iOCT. In all cases, the donor lenticules were adhered in the postoperative period.
  
  
  CONCLUSIONS
  iOCT helps in understanding that the donor lenticule is well apposed within 1 to 3 minutes with the technique of simultaneous positive intracameral pressure and external corneal massage. This knowledge minimizes the waiting time for graft apposition and prevents prolonged intraocular pressure elevation.
authors.affiliation: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Jeewan S
authors.initials: JS
authors.lastname: Titiyal
authors.forename: Manpreet
authors.initials: M
authors.lastname: Kaur
authors.forename: Ruchita
authors.initials: R
authors.lastname: Falera
authors.forename: Cijin P
authors.initials: CP
authors.lastname: Jose
authors.forename: Namrata
authors.initials: N
authors.lastname: Sharma
mesh_terms: D000368:Aged; D003317:Corneal Dystrophies, Hereditary / Q000503:physiopathology / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010865:Pilot Projects; D011446:Prospective Studies; D000267:Tissue Adhesions; D014019:Tissue Donors; D041623:Tomography, Optical Coherence; D066027:Transplant Recipients