i-PDEK: Microscope-integrated OCT–assisted pre-Descemet endothelial keratoplasty

Abstract

Four patients with pseudophakic corneal edema were subjected to pre-Descemet endothelial keratoplasty (PDEK) under the direct guidance of microscope-integrated optical coherence tomography (i-OCT). i-OCT facilitated successful type 1 big bubble formation during donor preparation, debridement of the hypertrophic epithelium, planning and placement of surgical wounds, descemetorrhexis with removal of remnant Descemet membrane tags, and identification of correct donor orientation and interface details. It was also possible to discern the stability of intraocular lens, flat iris configuration, adequate stromal hydration, and wound apposition on i-OCT. Preoperative visual acuity was counting fingers (50%), 0.78 logMAR (25%), and 1.48 logMAR (25%), whereas postoperative visual acuity was 0.6 logMAR (50%) and 0.3 logMAR (50%). At 6-months of follow-up, all grafts were clear and well attached, the mean central corneal thickness, graft size, graft thickness, and endothelial cell loss were 557.25 ± 13.45 μm, 7.75 ± 0.20 mm, 25.5 ± 2.64 μm, and 21.6 ± 0.02%, respectively. To conclude, i-OCT helped during various surgical steps of PDEK.

Comparison of Pre-Descemet Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty in Endothelial Decompensation

“…Although both methods of donor preparation are prone to donor tissue tears and losses, no such wastage was encountered in our study (the chances of unsuccessful tissue peeling during DMEK remain 2.66% while the success rate of type 1 big bubble formation during PDEK remains 71.7% to 92.3%), and intraoperative optical coherence tomography could have partly contributed to this. 9,10,17–21…”

“…Although both methods of donor preparation are prone to donor tissue tears and losses, no such wastage was encountered in our study (the chances of unsuccessful tissue peeling during DMEK remain 2.66% while the success rate of type 1 big bubble formation during PDEK remains 71.7% to 92.3%), and intraoperative optical coherence tomography could have partly contributed to this. 9,10,[17][18][19][20][21] Besides an easy donor preparation, the PDEK grafts also witnessed easier intracameral opening, better visibility, and lesser manipulations because of the presence of PDL that converts an extremely elastic DEC to a stiffer structure, acting as a splint that prevents scrolling. This could have also contributed to reduced incidence of graft detachment and, therefore, rebubbling after PDEK in our study.…”

“…All patients were operated under peribulbar anesthesia by the same corneal surgeon under the guidance of an intraoperative optical coherence tomograph (OPMI Lumera 700 and RESCAN 700; Carl Zeiss Meditec AG, Jena, Germany) following the steps previously described by us. 9,10…”

“…All patients were operated under peribulbar anesthesia by the same corneal surgeon under the guidance of an intraoperative optical coherence tomograph (OPMI Lumera 700 and RESCAN 700; Carl Zeiss Meditec AG, Jena, Germany) following the steps previously described by us. 9,10 Postoperative treatment in each group included administration of topical prednisolone acetate 1% eye drops (6 times a day for 1 week, tapered gradually until 6 months), 0.5% moxifloxacin 4 times/day for 4 weeks, and preservative-free artificial tears 6 times a day for 8 weeks. All patients were advocated the strict supine position for at least 12 hours after surgery, irrespective of the air bubble size for adequate tamponade.…”

Obstetrical forceps-induced Descemet membrane tears

“…[ 36 37 ] i-OCT may also improve the surgical success of posterior endothelial keratoplasty in eyes with hazy corneas. [ 38 ] Recent advances in the medical and surgical management of endothelial disorders in adults, such as Rho-kinase inhibitors, DMEK, and gene therapy, may also prove helpful for timely recovery of such lesions. [ 39 40 41 42 ]…”