Association Between Transient Interface Fluid on Intraoperative OCT and Textural Interface Opacity After DSAEK Surgery in the PIONEER Study

Abstract

Purpose To examine the association between transient interface fluid (TIF) and textural interface opacity (TIO) following DSAEK surgery using intraoperative optical coherence tomography (iOCT) in the PIONEER study. Methods All consecutive eyes that underwent DSAEK between October 2011 and September 2013 from the PIONEER intraoperative and perioperative OCT study were included. iOCT images were captured after lenticule apposition with complete air fill and after air-fluid exchange. Postoperative day (POD) 1 OCT images were obtained. Outcome variables included the presence of TIO at the graft-host junction and the presence of intraoperative and postoperative interface fluid on OCT. Results Seventy-six eyes from 69 patients which underwent DSAEK with iOCT were included. The mean age was 71 years (range 31-90). The two most common indications for surgery were Fuchs’ dystrophy (63%) and pseudophakic bullous keratopathy (24%). In 18/76 (23.7%) eyes, TIF was visible on iOCT post air-fluid exchange. Of these eyes, 14 developed TIO. TIO was observed in 18/76 (23.7%) eyes. TIF on iOCT was associated with a significantly higher rate of postoperative TIO (OR=47.25; p<0.0001). Sixteen of the 18 eyes that had TIF on iOCT had had resolution on the POD 1 OCT. There was no significant difference in mean graft thickness between eyes with TIF on iOCT and those without (p=0.58). Conclusions Eyes with TIF on iOCT are more likely to develop TIO in the postoperative period. It is believed that the process of gap closure results in TIO, possibly secondary to precipitated solutes, retained viscoelastic, or lamellar irregularities caused by delayed adhesion or uneven matching of lamellar fibrils.

Evaluation of Time to Donor Lenticule Apposition Using Intraoperative Optical Coherence Tomography in Descemet Stripping Automated Endothelial Keratoplasty

“…5,6,9,14,15 In our study, the continuous feedback provided by the microscope-integrated iOCT helped in the assessment of the completion of DM scoring, the orientation of the unfolded graft, position of the incision, the relationship of the incision and graft edge, and the position and stability of the IOL.…”

“…3,4 Intraoperative optical coherence tomography (iOCT) is an emerging entity with potential benefits in both anterior and posterior segment surgeries. [5][6][7][8][9][10][11] It has the potential to increase our understanding of the tissue alterations that occur during surgical manipulations. We herein evaluated the role of microscope-integrated iOCT to assess the time to donor apposition in cases undergoing Descemet stripping automated endothelial keratoplasty (DSAEK).…”

Intraoperative optical coherence tomography: past, present, and future

“…9,12,13,22,23,27,29,32,39,41,42 Using intraoperative OCT surgeons are able to obtain immediate feedback on the status of the surgical procedure.…”

“…In fact, residual subclinical interface fluid at the end of the case has been associated with postoperative textural interface opacity. 39 In the DISCOVER study, intraoperative OCT findings resulted in additional surgical maneuvers in 41% of patients. 27 In the PIONEER study, intraoperative OCT identified residual persistent fluid in 48% of eyes that resulted in additional surgical maneuvers.…”

“…[6][7][8][9][11][12][13][14][15][16][17][18][21][22][23]27,28,[32][33][34][35][36][37][38][39][40][41] The PIONEER study was a large prospective clinical study (n = 531) examining the role of intraoperative OCT with a microscope-mounted portable OCT system in ophthalmic surgery. 13 The DISCOVER study is a subsequent prospective clinical study (n = 227) examining microscope-integrated OCT in ophthalmic surgery.…”