Efficacy of Intraoperative Anterior Segment Optical Coherence Tomography during Descemet's Stripping Automated Endothelial Keratoplasty

Purpose To correlate intraoperative interface fluid dynamics during Descemet stripping automated endothelial keratoplasty (DSAEK) surgery using intraoperative optical coherence tomography (iOCT) in the PIONEER (Prospective Intraoperative and Perioperative Ophthalmic ImagiNg with Optical CohEncE TomogRaphy) study with postoperative outcomes. Design Prospective consecutive, interventional, comparative case series Participants One hundred and seventy-eight eyes of 173 patients undergoing DSAEK from the Cole Eye Institute, Cleveland, USA. Methods Eyes 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 two different DSAEK techniques, one that used an active air infusion system and one that did not. Main Outcome Measures interface fluid metrics, graft non-adherence Results iOCT measurements of interface fluid following final surgical manipulations and immediately prior to leaving the OR identified that Total Fluid Volume (p=0.002), Largest Fluid Volume Pocket (p=0.002), Max Fluid Area (p=0.006), Mean Fluid Thickness (p=0.03), and Max Fluid Thickness (p=0.01) significantly correlated with graft non-adherence rates within the first postoperative week. Following placement and optimization of intraoperative lenticle adherence, iOCT revealed a significant difference between the area, volume and thickness of maximum fluid pockets between the two surgical techniques, though both techniques resulted in significant reduction of interface fluid during the procedure. Conclusions Larger residual interface fluid volume, area, and thickness at the end of surgery detected with iOCT are associated with early graft non-adherence and can be quantified with an automated algorithm. iOCT imaging can successfully capture technique-dependent differences in fluid dynamics during DSAEK surgery.

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“…6 Other case series have successfully used iOCT to show interface fluid drainage after corneal stab incisions. 11, 12 Similarly, Ide et. al.…”

Section: Discussionmentioning

confidence: 90%

Intraoperative Interface Fluid Dynamics and Clinical Outcomes for Intraoperative Optical Coherence Tomography–Assisted Descemet Stripping Automated Endothelial Keratoplasty From the PIONEER Study

Hallahan

Cost

Goshe

et al. 2017

American Journal of Ophthalmology

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“…The wound interface pattern can be shown by AS-OCT during DSAEK [ 36 ] or after PKP. Miyakoshi et al [ 39 ] suggested that AS-OCT is useful for detecting the interface fluid between the host cornea and the graft during a DSAEK. Similarly, Sung and Yoon [ 40 ] showed that the alignment pattern of the wound interface after PKP differed according to the clinical diagnosis before surgery.…”

Section: Assessment Of Descemet's Membrane: Descemet's Membrane Dementioning

confidence: 99%

Clinical Applications of Anterior Segment Optical Coherence Tomography

Lim

2015

Journal of Ophthalmology

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Anterior segment optical coherence tomography (AS-OCT) was recently developed and has become a crucial tool in clinical practice. AS-OCT is a noncontact imaging device that provides the detailed structure of the anterior part of the eyes. In this review, the author will discuss the various clinical applications of AS-OCT, such as the normal findings, tear meniscus measurement, ocular surface disease (e.g., pterygium, pinguecula, and scleromalacia), architectural analysis after cataract surgery, post-LASIK keratectasia, Descemet's membrane detachment, evaluation of corneal graft after keratoplasty, corneal deposits (corneal dystrophies and corneal verticillata), keratitis, anterior segment tumors, and glaucoma evaluation (angle assessment, morphological analysis of the filtering bleb after trabeculectomy, or glaucoma drainage device implantation surgery). The author also presents some interesting cases demonstrated via AS-OCT.

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“…AS‐OCT may be used to predict Descemet's stripping automated endothelial keratoplasty graft failure by elucidating the presence of residual host membrane tissue at the graft . Miyakoshi et al have also proposed AS‐OCT as a means of detecting fluid between the host‐donor interface in Descemet's stripping automated endothelial keratoplasty . Knecht et al have reported on the use of hand‐held AS‐OCT for this purpose .…”

Section: Resultsmentioning

confidence: 99%

Anterior segment optical coherence tomography and its clinical applications

Wang

Cornish

Grigg

et al. 2019

Clinical and Experimental Optometry

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Anterior segment optical coherence tomography (AS-OCT) has become one of the cornerstones of non-contact imaging modalities for assessing such structures as the cornea, anterior chamber angle, aqueous outflow pathway, sclera, and ocular surface structures. As such, it has a broad range of clinical applications, which have been independently reported in the literature. This paper aims to present a review of extant literature on the utility of AS-OCT and its efficacy in clinical applications, and to evaluate the quality of available evidence. The following databases were searched from inception to 24 June 2018: Medline via Ovid, Cochrane Central Register of Controlled Trials, PubMed, World Health Organization International Clinical Trials Registry Platform, EMBASE, and CINAHL. Bibliographies of identified papers were hand searched. Inclusion criteria: articles describing or assessing the use of OCT for visualising the AS. The authors excluded studies without an identified primary outcome variable. One author independently selected studies, extracted data, and assessed for risk of bias using PRISMA guidelines. This review included 82 studies, of which there were 11 cohort studies, 37 case series, 10 case studies, 21 comparative observational studies, and three non-systematic review articles. Primary outcome variables included anterior chamber angle, angle opening distance, angle recess area, trabecular iris angle, trabeculairis space area, corneal thickness, tear meniscus height, tear meniscus area, tear meniscus volume, and the morphology of AS structures, including the ocular surface, blebs, flaps, and graft sites. This review attempts to encompass the breadth and depth of evidence for AS-OCT in the arena of diagnostics, therapeutics, and prognostics. At the same time, it brings to light the dearth of high-level evidence on this topic, suggesting the important role of randomised controlled trials and meta-analyses for the future validation of this technology.

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Efficacy of Intraoperative Anterior Segment Optical Coherence Tomography during Descemet's Stripping Automated Endothelial Keratoplasty

Cited by 16 publications

References 14 publications

Intraoperative Interface Fluid Dynamics and Clinical Outcomes for Intraoperative Optical Coherence Tomography–Assisted Descemet Stripping Automated Endothelial Keratoplasty From the PIONEER Study

Intraoperative Interface Fluid Dynamics and Clinical Outcomes for Intraoperative Optical Coherence Tomography–Assisted Descemet Stripping Automated Endothelial Keratoplasty From the PIONEER Study

Clinical Applications of Anterior Segment Optical Coherence Tomography

Anterior segment optical coherence tomography and its clinical applications

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