Dataset Information

Intraoperative Optical Coherence Tomography for Enhanced Depth Visualization in Deep Anterior Lamellar Keratoplasty From the PIONEER Study.

ABSTRACT: Deep anterior lamellar keratoplasty (DALK) is a challenging procedure that often results in conversion to penetrating keratoplasty. Preservation of Descemet membrane (DM) relies on indirect visualization of surgical planes. We describe a technique for enhanced visualization of key steps in DALK with intraoperative optical coherence tomography.Using a microscope-mounted spectral domain optical coherence tomography system, high-resolution images of various steps were obtained.Specifically, images were obtained of the trephination depth and proximity of the cannula tract to DM. Other key steps such as air cannula placement, assessment of the DM position and integrity after attempted big-bubble delivery, and assessment of graft-host apposition were readily visualized. The presence of intrastromal emphysema after air injection decreased visualization of deeper structures.Intraoperative optical coherence tomography allows visualization of depth-dependent anatomy and changes from specific surgical interventions during DALK not appreciated with the en face operating microscope view and has the potential to facilitate big-bubble delivery. Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT02423161.

SUBMITTER: Au J

PROVIDER: S-EPMC4529367 | biostudies-literature | 2015 Sep

REPOSITORIES: biostudies-literature

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Intraoperative Optical Coherence Tomography for Enhanced Depth Visualization in Deep Anterior Lamellar Keratoplasty From the PIONEER Study.

Au John J Goshe Jeffrey J Dupps William J WJ Srivastava Sunil K SK Ehlers Justis P JP

Cornea 20150901 9

<h4>Purpose</h4>Deep anterior lamellar keratoplasty (DALK) is a challenging procedure that often results in conversion to penetrating keratoplasty. Preservation of Descemet membrane (DM) relies on indirect visualization of surgical planes. We describe a technique for enhanced visualization of key steps in DALK with intraoperative optical coherence tomography.<h4>Methods</h4>Using a microscope-mounted spectral domain optical coherence tomography system, high-resolution images of various steps wer ...[more]

PMID: 26114817

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Project description:BackgroudPrevious studies of internal graft-host malappositions have not dealt with the precise ways in which each malapposition affected post-penetrating keratoplasty (post-PK) visual outcomes. In this study, we reviewed our post-PK and post-deep anterior lamellar keratoplasty (post-DALK) keratoconic patients and used anterior segment optical coherence tomography (AS-OCT) to evaluate the associations between graft-host interface (GHI) characteristics and visual outcomes.MethodsNovel GHI metrics included: mean graft-host touch (GHT), total prevalence of malapposition proportion (Pm), frequency of apposition (F), size of malapposition (Sm), junctional graft thickness (Tg), junctional host thickness (Th) and the absolute value of difference between Tg and Th (|Tg-Th|). We connected the external and internal junction points of GHI (GHT) and drew a straight line through the central point, perpendicular to both sides of the cornea. Tg and Th were the thicknesses at cross-points 1?mm away from the meeting point on the external side of the graft and host, respectively. Linear regression analysis was used to describe associations between GHI metrics and postsurgical visual outcomes [logarithm of minimum angle of resolution best-corrected visual acuity (logMAR BCVA), spherical equivalent diopter (SE), diopter of spherical power (DS), diopter of cylindrical power (DC) and keratometric astigmatism (Astig value)].ResultsWe enrolled 22 post-PK and 23 post-DALK keratoconic patients. Compared with the regular-apposition results, GHT was decreased in step and gape patterns, and increased in hill and tag patterns. SE increased averagely by 6.851, 5.428 and 5.164 diopter per 1% increase in: F (step) [??=?6.851; 95% Confidence interval (CI)?=?2.975-10.727; P?=?0.001]; F (graft step) [??=?5.428; 95% CI?=?1.685-9.171; P?=?0.005]; and Pm [??=?5.164; 95%CI?=?0.913-9.146; P?=?0.018], respectively. SE increased averagely by 0.31 diopter per 10-?m increment in |Tg-Th| [??=?0.031; 95% CI?=?0.009-0.054; P?=?0.007]. LogMAR BCVA increased (on average) by 0.01 per 10-?m increment in both GHT [??=?0.001; 95% CI?=?0-0.002; P?=?0.030]. and Tg [??=?0.001; 95% CI?=?0.001-0.002; P?=?0.001]. Astig value increased on average by 0.17 diopter per 10-?m increment in Sm [??=?0.017; 95% CI?=?0-0.033; P?=?0.047].ConclusionThis investigation of GHI characteristics suggests explanations for varied ametropia in keratoconic eyes and has potential significance as a reference for promoting pre-surgical planning and technology for corneal transplantation.

Project description:PurposeTo correlate intraoperative interface fluid dynamics during Descemet stripping automated endothelial keratoplasty (DSAEK) using intraoperative optical coherence tomography (iOCT) in the Prospective Intraoperative and Perioperative Ophthalmic Imaging with Optical Coherence Tomography (PIONEER) study with postoperative outcomes.DesignProspective consecutive, interventional, comparative case series.ParticipantsOne hundred seventy-eight eyes of 173 patients undergoing DSAEK from the Cole Eye Institute, Cleveland, Ohio.MethodsEyes that underwent DSAEK between October 2011 and March 2014 from the PIONEER intraoperative and perioperative OCT study were included. An automated interface fluid segmentation algorithm evaluated intraoperative dynamics of interface fluid before and after surgical manipulations. iOCT images were also captured at multiple intraoperative time points for 2 different DSAEK techniques, 1 that used an active air infusion system and 1 that did not.Main outcome measuresInterface fluid metrics, graft nonadherence.ResultsiOCT measurements of interface fluid after final surgical manipulations and immediately before leaving the operating room identified that total fluid volume (P = .002), largest fluid volume pocket (P = .002), max fluid area (P = .006), mean fluid thickness (P = .03), and max fluid thickness (P = .01) significantly correlated with graft nonadherence rates within the first postoperative week. After placement and optimization of intraoperative lenticle adherence, iOCT revealed a significant difference between the area, volume, and thickness of maximum fluid pockets between the 2 surgical techniques, but both techniques resulted in significant reduction of interface fluid during the procedure.ConclusionsLarger residual interface fluid volume, area, and thickness at the end of surgery detected with iOCT are associated with early graft nonadherence and can be quantified with an automated algorithm. iOCT imaging can successfully capture technique-dependent differences in fluid dynamics during DSAEK.

Project description:PurposeTo measure by ultralong scan depth optical coherence tomography (UL-OCT) dimensional changes in the anterior segment of human eyes during accommodation.DesignEvaluation of diagnostic test or technology.ParticipantsForty-one right eyes of healthy subjects with a mean age of 34 years (range, 22-41 years) and a mean refraction of -2.5 ± 2.6 diopters were imaged in 2 repeated measurements at minimal and maximal accommodations.MethodsA specially adapted and designed UL-OCT instrument was used to image from the front surface of the cornea to the back surface of the crystalline lens. Custom software corrected the optical distortion of the images and yielded the biometric measurements. The coefficient of repeatability and the intraclass correlation coefficient were calculated to evaluate the repeatability and reliability.Main outcome measuresAnterior segment parameters and associated repeatability and reliability upon accommodation. The dimensional results included central corneal thickness (CCT), anterior chamber depth and width (ACD, ACW), pupil diameter (PD), lens thickness (LT), anterior segment length (ASL = ACD + LT), lens central position (LCP = ACD + 1/2LT), and horizontal radii of the lens anterior and posterior surface curvatures (LAC, LPC).ResultsRepeated measurements of each variable within each accommodative state did not differ significantly (P>0.05). The coefficients of repeatability (CORs) and intraclass correlation coefficients for CCT, ACW, ACD, LT, LCP, and ASL were excellent (1.2%- 3.59% and 0.998-0.877, respectively). They were higher for PD (18.90%-21.63% and 0.880-0.874, respectively) and moderate for LAC and LPC (34.86%-42.72% and 0.669-0.251, respectively) in the 2 accommodative states. Compared with minimal accommodation, PD, ACD, LAC, LPC, and LCP decreased and LT and ASL increased significantly at maximal accommodation (P<0.05), whereas CCT and ACW did not change (P>0.05).ConclusionsThe UL-OCT measured changes in anterior segment dimensions during accommodation with good repeatability and reliability. During accommodation, the back surface of the lens became steeper as the lens moved forward.Financial disclosure(s)The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Dataset Information

Intraoperative Optical Coherence Tomography for Enhanced Depth Visualization in Deep Anterior Lamellar Keratoplasty From the PIONEER Study.

Publications

Intraoperative Optical Coherence Tomography for Enhanced Depth Visualization in Deep Anterior Lamellar Keratoplasty From the PIONEER Study.

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