title: Intraoperative optical coherence tomography in descemet stripping automated endothelial keratoplasty: pilot experiences.
abstract: OBJECTIVE
  To assess the added value of intraoperative optical coherence tomography (iOCT) in evaluating graft adhesion and graft interface in patients undergoing descemet's stripping automated endothelial keratoplasty (DSAEK).
  
  
  METHODS
  This is a prospective single-center case series comprising 8 eyes of 8 patients consecutively scheduled for DSAEK surgery. iOCT imaging was performed after insertion of the graft, after pressurizing the eye, and at the end of surgery (three images per surgery). At each stage of surgery, corneal thickness and the widest gap between the recipient and the graft (i.e., maximal interface width) were measured using an image processing tool. Follow-up measurements were taken at 1 day, 3 and 6 months, post-operatively.
  
  
  RESULTS
  Imaging was performed in 21 of 24 scheduled imaging intervals, and required little to no additional surgical time. At the end of surgery, iOCT showed persisting interfaces in six cases. One case showed a full graft detachment necessitating surgical intervention.
  
  
  CONCLUSIONS
  Real-time iOCT is a safe, efficient, and useful tool in assessing graft adherence in DSAEK surgery. With adequate analysis software, iOCT has the potential to be a paradigm-shifting development in posterior lamellar surgery and could aid the clinician in further lowering the rates of graft dislocation after DSAEK.
authors.affiliation: Department of Ophthalmology, University Medical Center, Heidelberglaan 100, 3508GA, Utrecht, The Netherlands.
authors.forename: Jasper G
authors.initials: JG
authors.lastname: Steverink
authors.affiliation: Department of Ophthalmology, University Medical Center, Heidelberglaan 100, 3508GA, Utrecht, The Netherlands. r.p.l.wisse@umcutrecht.nl.
authors.forename: Robert P L
authors.identifier: http://orcid.org/0000-0002-2844-9868
authors.initials: RPL
authors.lastname: Wisse
mesh_terms: D000368:Aged; D003315:Cornea / Q000473:pathology* / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D000267:Tissue Adhesions / Q000175:diagnosis* / Q000473:pathology; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: DSAEK; Intraoperative optical coherence tomography; Live OCT; Posterior lamellar keratoplasty; RESCAN