Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization

Namrata Sharma, Pranita Sahay, Prafulla K Maharana, Praveen Kumar, Saima Ahsan, Jeewan S Titiyal Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Namrata SharmaDepartment of Ophthalmology, Dr. Rajendra Prasad Centre for Opht...

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Autores principales:	Sharma N, Sahay P, Maharana PK, Kumar P, Ahsan S, Titiyal JS
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	dmek descemet membrane endothelial keratoplasty ioct microscope-integrated intra-operative optical coherence tomography. Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/a4e9111735f3450892f735414b758725
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spelling	oai:doaj.org-article:a4e9111735f3450892f735414b7587252021-12-02T11:34:48ZMicroscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization1177-5483https://doaj.org/article/a4e9111735f3450892f735414b7587252020-03-01T00:00:00Zhttps://www.dovepress.com/microscope-integrated-intraoperative-optical-coherence-tomography-guid-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Namrata Sharma, Pranita Sahay, Prafulla K Maharana, Praveen Kumar, Saima Ahsan, Jeewan S Titiyal Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Namrata SharmaDepartment of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room- 482, 4th Floor, New Delhi 110029, IndiaTel +91 9810856988Email namrata.sharma@gmail.comPurpose: To assess the utility of microscope-integrated intraoperative optical coherence tomography (Mi-OCT) for performing Descemet membrane endothelial keratoplasty (DMEK) in corneas with poor visualization.Methods: It is a prospective interventional case series that included 25 consecutive cases of corneal decompensation with poor visualization that underwent Mi-OCT-guided DMEK at a tertiary eye care centre. The main outcome measures were graft attachment on day 3 and requirement for re-bubbling.Results: The etiology for corneal decompensation was pseudophakic bullous keratopathy (n=17), Fuchs endothelial corneal dystrophy (n=4), failed graft (n=2), iridocorneal endothelial syndrome (n=1) and failed Descemet stripping automated endothelial keratoplasty (n=1). Complete graft attachment was noted in 72% of cases. Graft detachment was noted in 16% of cases which required re-bubbling. No intervention was done for shallow peripheral detachment (n=2) and peripheral Descemet membrane (DM) fold (n=1). All grafts were attached at six-months follow-up. The mean corrected distance visual acuity and central corneal thickness improved from 1.4 ± 0.5 logMAR and 799.6 ± 110.9 μm at baseline to 0.3 ± 0.3 logMAR and 536.28 ± 11.44 um at six months. Mi-OCT was helpful in visualizing areas of peripheral anterior synechiae, missing DM, retained DM tags after descemetorhexis, DMEK roll configuration and orientation in the injector and anterior chamber, interface fluid and peripheral folds in the DMEK graft.Conclusion: Mi-OCT helps in identification of the anatomy and dynamics of the host DM, DM roll and anterior chamber in cases with poor visualization and is a useful tool while performing DMEK in such cases.Keywords: DMEK, descemet membrane endothelial keratoplasty, iOCT, Mi-OCT, microscope-integrated intra-operative optical coherence tomographySharma NSahay PMaharana PKKumar PAhsan STitiyal JSDove Medical Pressarticledmekdescemet membrane endothelial keratoplastyioctmicroscope-integrated intra-operative optical coherence tomography.OphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 643-651 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	dmek descemet membrane endothelial keratoplasty ioct microscope-integrated intra-operative optical coherence tomography. Ophthalmology RE1-994
spellingShingle	dmek descemet membrane endothelial keratoplasty ioct microscope-integrated intra-operative optical coherence tomography. Ophthalmology RE1-994 Sharma N Sahay P Maharana PK Kumar P Ahsan S Titiyal JS Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization
description	Namrata Sharma, Pranita Sahay, Prafulla K Maharana, Praveen Kumar, Saima Ahsan, Jeewan S Titiyal Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Namrata SharmaDepartment of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room- 482, 4th Floor, New Delhi 110029, IndiaTel +91 9810856988Email namrata.sharma@gmail.comPurpose: To assess the utility of microscope-integrated intraoperative optical coherence tomography (Mi-OCT) for performing Descemet membrane endothelial keratoplasty (DMEK) in corneas with poor visualization.Methods: It is a prospective interventional case series that included 25 consecutive cases of corneal decompensation with poor visualization that underwent Mi-OCT-guided DMEK at a tertiary eye care centre. The main outcome measures were graft attachment on day 3 and requirement for re-bubbling.Results: The etiology for corneal decompensation was pseudophakic bullous keratopathy (n=17), Fuchs endothelial corneal dystrophy (n=4), failed graft (n=2), iridocorneal endothelial syndrome (n=1) and failed Descemet stripping automated endothelial keratoplasty (n=1). Complete graft attachment was noted in 72% of cases. Graft detachment was noted in 16% of cases which required re-bubbling. No intervention was done for shallow peripheral detachment (n=2) and peripheral Descemet membrane (DM) fold (n=1). All grafts were attached at six-months follow-up. The mean corrected distance visual acuity and central corneal thickness improved from 1.4 ± 0.5 logMAR and 799.6 ± 110.9 μm at baseline to 0.3 ± 0.3 logMAR and 536.28 ± 11.44 um at six months. Mi-OCT was helpful in visualizing areas of peripheral anterior synechiae, missing DM, retained DM tags after descemetorhexis, DMEK roll configuration and orientation in the injector and anterior chamber, interface fluid and peripheral folds in the DMEK graft.Conclusion: Mi-OCT helps in identification of the anatomy and dynamics of the host DM, DM roll and anterior chamber in cases with poor visualization and is a useful tool while performing DMEK in such cases.Keywords: DMEK, descemet membrane endothelial keratoplasty, iOCT, Mi-OCT, microscope-integrated intra-operative optical coherence tomography
format	article
author	Sharma N Sahay P Maharana PK Kumar P Ahsan S Titiyal JS
author_facet	Sharma N Sahay P Maharana PK Kumar P Ahsan S Titiyal JS
author_sort	Sharma N
title	Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization
title_short	Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization
title_full	Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization
title_fullStr	Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization
title_full_unstemmed	Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization
title_sort	microscope integrated intraoperative optical coherence tomography-guided dmek in corneas with poor visualization
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/a4e9111735f3450892f735414b758725
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Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization

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