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Review
. 2023 Apr 22;12(9):3048.
doi: 10.3390/jcm12093048.

Intraoperative OCT for Lamellar Corneal Surgery: A User Guide

Antonio Moramarco  1   2 , Natalie di Geronimo  1   2 , Matteo Airaldi  3   4 , Lorenzo Gardini  1   2 , Francesco Semeraro  3   4 , Danilo Iannetta  1   2 , Vito Romano  3   4 , Luigi Fontana  1   2
Affiliations
Review

Intraoperative OCT for Lamellar Corneal Surgery: A User Guide

Antonio Moramarco et al. J Clin Med. .

Abstract

Intraoperative OCT is an innovative and promising technology which allows anterior and posterior segment ocular surgeons to obtain a near-histologic cross-sectional and tomographic image of the tissues. Intraoperative OCT has several applications in ocular surgery which are particularly interesting in the context of corneal transplantation. Indeed, iOCT images provide a direct and meticulous visualization of the anatomy, which could guide surgical decisions. In particular, during both big-bubble and manual DALK, the visualization of the relationship between the corneal layers and instruments allows the surgeon to obtain a more desirable depth of the trephination, thus achieving more type 1 bubbles, better regularity of the plane, and a reduced risk of DM perforation. During EK procedures, iOCT supplies information about proper descemetorhexis, graft orientation, and interface quality in order to optimize the postoperative adhesion and reduce the need for re-bubbling. Finally, mushroom PK, a challenging technique for many surgeons, can be aided through the use of iOCT since it guides the correct apposition of the lamellae and their centration. The technology of iOCT is still evolving: a larger field of view could allow for the visualization of all surgical fields, and automated tracking and iOCT autofocusing guarantee the continued centration of the image.

Keywords: DALK; anterior segment imaging; artificial intelligence; corneal transplantation; endothelial keratoplasty; multimodal imaging; mushroom PK; ophthalmic imaging; optical coherence tomography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Seagull wing sign.
Figure 2
Figure 2
BB-DALK. (A) Stromal trephination. (B) Detail of the vertical hyperreflective band along the anterior stroma. (C) Insertion of the cannula. (D) Injection of air and bubble formation. (E) Bubble profile. (F) Detail of bubble and trephination.
Figure 3
Figure 3
DSAEK preparation (A) Pre-cut thickness. (B) Post-cut thickness.
Figure 4
Figure 4
DSAEK. (A) Pull-through insertion. (B) Deployment. (C) Partial AC filling. (D) Interface fluid. (E) Apposition and AC filling.
Figure 5
Figure 5
DMEK. (A) Deschemetorexhis. (B) Graft scroll. (C) Dirisamer maneuver. (D) Graft orientation and interface fluid. (E) AC filling.
Figure 6
Figure 6
Mushroom PK. (A) Dissection. (B) Trephination. (C) Internal lamella placement. (D) External lamella placement. (E) Interface.
See this image and copyright information in PMC

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